HomeMy WebLinkAboutCOM2003-00028 - COM Application - 2/18/2003 FORM MUST BE COMPLETED IN INK PER j�r '
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION EE8 18 2003
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Belfair(360)275-4467 Elma(360)482-5269 Seattle(206)4169r* CE DAR ST.
On the Web wwwco.mason.wa.us
APPLIC NT INFORMATION In� 1 //11 CONTRACTOR INFORMATION
Owner I"Il t-Y�;tw 9151 i'1'l0.a 1 0 nc • Contractor Name
Mailing Address II Mailing Address
City StateWR Zip Codes City State_Zip C0 le
Phone (&L4c)(o-30}3 Other Ph. L::W -11 3 Phone Other Ph.
Lien/Title Holder Jrhe��L•P1 vet I *LOD
Contractor Reg.# Exp.
E-mail Address E-mail Address
SEPTIC/WATER SYSTEM INFORMATION -Conned to New Septic Existing Septic X Connect to Sewer
System_Name of Sewer System Well Water System
Name of Water System 'S vm 1430--1c)
PARCEL INFORMATION- 12 digit Tax Parcel No. 4GO I a / '30a / OD 1_'O Fire District 1
Legal Description 14, WW( Q y/
Site Address(Please include street name,street number and city) I I tb '
Directions to site %' hel{av15p?dLV.n 12vt+Qf �eEj-Dn (},uy )Ult �zn iMnyp � rl•P i a�FT
Will timber be cut and sold in parcel preparation? (Yes/No) NC;'
Lake River/Creek Pond Wetland Seasonal Runoff Stream
-Slopes or Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB- New Add Alt 0001hipair n Other Use of Building
Is this permit submittal the result of a Stop Work Notice,Corre ion Notice or other enforcement action? (Yes/No) _
Describe Work
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE- 1 at Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq.ft.
Garage Attached Detached Carport Attached Deta0ed
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 WOK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on ownWs,bgh represents that the
information provided is accurate and grants employees of Mason County access to the above described property and aWcai'tpgfof a/r dinspection
of this project.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or permit r - da,AgKrZeiv gment
of such is by signature below: l`v'
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that 1 am Jr6dilib*tared as e
the Contractor Registration law RCW 18.27 and am aware of the ordi- contractor in the State of Washington a to aj a of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which ddllffaa 1� ed and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes be made
obtaining approval. without first obtaining approval.
Date -Z3-A3 X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date^Submittal Amount Due ✓ 1 Receipt�10
ae E
Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
JFWreMarshal
Valuation$
reg °l e 6
a - r¢
Building Permit Fee ° Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
�° a` MAE
TOTAL FEES
MASON COUNTY PERMIT NO. e� M24fb3t)M2-S
` BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584 1
Shelton(360)427-9670 Belfair(360)275-4467 Elms.(360)482-5269 Seattle(206)464-6968
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner r Contractor Name
Mailing Address ++ :v• + ,•f , 1 Mailing Address
City - ' + 1 - State_1'+Zip Code r c{ City State_Zip Co Je.
Phone(-+C/)'-1 ? ' : i,� Other Ph. ( � L) ti-'x)J- , I a� Phone LJ Other Ph.
Lien/Title Holders Contractor Reg.# Exp.
E-mail Address E-mail Address
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System_Name of Sewer System Well X Water S tem
Name of Water System V-7, . ;Z, -�_ .(
PARCEL INFORMATION- 12 digit Tax Parcel No. ... � I 1 / + / :a f C: Fire District
Legal Description W 1 b.
Site Address(Please include street name,street number and city) I IL "
Directions to site r ( r f•c t If I+.
Will timber be cut and sold in parcel preparation? (Yes/No) Nr—
Lake River/Creek Pond Wetland Seasonal Runoff S tream
Slo es ores or B�l-uffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB-New Is- Add 4' Alt,''.;.) ,RepairF^n,'z, Other Use of Building
Is this permit submittal the 7esult of a Stop Work Notice,Corte n Notice or other enforcement action? (Yes/No)
Describe Work
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE- 1 at Floor 2nd Floor
3rd Floor Loft Basement Deck Other s .ft.
Garage Attached Detached Carport Attached Detac hed
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) o)
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 WOI K IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.The owner or agent on owner's behi f,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.Owner/,Pukder acknowledges submission of inaccurate Information may result in a stop work order or permit revoca on.Acknowledgment
of such is by signaturb below: R (�C
OWNER AFFIDAVIT"[-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I Arn kldrttlywigta as a
the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor In the State of Washington and that! ware of the ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for which thk k int A is�gpQ and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No hang a made
obtaining approval. without first obtaining approval. 1 426 , CEDAR
_. ----- r , ST.t
X. �-- ',f.y•'"`' Date,,, , X ate
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by i'- Date- y`�.� �Submyittal Amount Due i Receipt No.
..OW h
..ARPS.....e. . MEM . e ..
Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation$ v N °° J .. 0s0-7 "� +4' ki8� E *d3'r'
6 "' s 6'�°°5 a' s� 'Fol vet 6 b¢d"wa¢pera'w a red,6 s"i3' a a e ?�- e ,� k ,fir 3 a a
.�.P a m `reaS°v;,9 �, ea, v,�e.a.t,.,..+. ss•m,. .x., r.q",..Yeua.e. .rv. .`" .d.x a.e �° 5.,:,,.s, , ,,a, �,rt om
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Woad/Gas/Pellet Stove Fee State Fee '
Violation Fee Pre-Paid at Submittal ( )
d `e m' TOTAL FEES
.�% .. ems¢:•� ass m„ �€+'�..,r�s 4, 00S',+a'�-RA a
1
MASON COUNTY PERMIT NO. 121�-OM2ct�3122z�
` 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
On the Web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner _ t i Contractor Name
Mailing Address )• tt.++ ' ; !" t Mailing Address
City Statea Zip Code `: _'.mil City State_Zip Code
Phone (_D " � T . Other Ph. Y'yl.^! 2� Phone L_j Other Ph. (-- )
Lien/TitIe Holder 1 ...._9 : o tklhr-r Contractor Reg.# Exp.
E-mail Address E-mail Address
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic 7t Conne7Sewer
System_Name of Sewer System Well � Water System
Name of Water System F�' _3 ;,rntvr C :' ^:' WF-L
PARCEL INFORMATION- 12 digit Tax Parcel No. _t .:+':a / ,�X Fire District t
Legal Description P k% tJ 1/4 NL�!(�G; . i_ ,� !i w/
Site Address(Please include street name,street number and city) I I gf5O N I°7 e )9' :t"
Directionsto site :ii., rt`>r.u2�s� Irv,* (i 6 Y� [:•� �} t IUf1 nrl Inuxii-el:a^ e Ln!- It
Will timber be cut and sold in parcel preparation? (Yes/No) (VO
Lake River/Creek_Pond Wetland Seasonal Runoff Stream
-Slopes or Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑
TYPE OF JOB- New�_Add g Alt 00)i Aepaire)rl Other Use of Building
Is this permit submittal the result of a Stop Work Notice,Corre Ion Notice or other enforcement action? (Yes/No)
Describe Work
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE- tat 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 WIT IN 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 s s ,ry,;�_�vlaw and inspection
of this project.Owner/Builder acknowledges submission of inaccurate information may result in a stop work order or perrh7($�,�10.*01edgment
of such is by signature below: � �11
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify t 8hurn aur&nnt��istered as a ,
the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Washington and that I am aware a ordinance
nance requirements for which this permit is issued and that all work will be requirements regulating the work for4210 tJtle pq ,(�Js§t�d and all
done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith. o�ya;}'fQ#S�haA a made
obtaining approval. without first obtaining approval.
X :: .; -�: - - a !'—` �" Datfl-q-/3-60- X date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by --� Dater / , Submittal Amount Due ! ( ° -' Receipt No. `" t
Building Department
Doe Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
a
Valuation$
MEMO, aa� �" 3 em"I E ° N. °�ts �� ,a�ea ae" a"e I+rb � md
111 Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal ( )
,3g °d1 `: TOTALFEES
MASON COUNTY PERMIT N0. B.D�_
BUILDING PI llMIT APPLICATION[
426 W Cedar/RO.Box 186,Shelton,WA 98584
Shelton(360)427-9670 Bel&rir (360)275-4467 Elma.(360)462-5269 Seattle(2001 4 6 4-6968
On the Web www.co.mason.wa.us
APPLICANT-INFORMATION CONTRACTOR INFORMATION
Owner t III) •,r f`('leu•_ t i r1C Conllactot Name
Mailing Address 10 t,(.' ll�,), ki"� ((3( Mailing Address
City'�Vd k tLA-N SlaleWH Zip Ccdef-' c City_ Siate_Zip Code
Phone (3(gQj_)14�Olher Ph. (,IV 13110116 (_�_ Other Ph.
t Llen/Thle I{older Ja r+�e�b C•G1 yet 1 Siasnr� iI�nLhnt Contractor Reg.# Exp.
E-mail Address —� E-mail Address
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect tc Sewer
System—Name of Sewer System Well X Water S stem
Name of Water System `�> '� iFL 4 014
PARCEL INFORMATION- 12 digit Tax Parcel No. 1..13U I-A ! "a1 /Sy*3 1_4f,) Fire District
' Legal Description P-*n (4W f/+1, N1�14J GRSAW
Site Address(Please include street name,street number and city) a
Directions to site !J{)C I [T t�> tr f lvn rl on t
Will timber be cut and sold in parce(preparation? (Yes/No) Na
' lake River/Creek Pond—Welland Seasonal Runol( Stream
slopes or Bluffs
PERMANENTRESIDENCELI SEASONAL RESIDENCE Q
TYPE OF JOB- Newf 1 Add AIt(2L4 Aspair A Other Use of Building
Is this permit submittal the result of a Stop Work Notice,Correiff on Notice or other enforcement action? (Yes/No);
Describe Work
No.of Bedrooms No.of Bathrooms SQUARE FOOTAGE- tat Floor 2nd Floor
3rd Floor I-oft Basement Deck Other sq.ft.
Garage Attached Detached Carport Attached Detac�isd
i
t MOBILE HOME INFORMATION- Make, Model _Model Year
Length Width Serial No. No.of Bedrooms No.o1 Bathrooms
Type of Heat Purchase Price$ Replacement Unit? (Yes/No)
Installer Name Certification No.
_NOTICE:THIS PERMIT BECOMES NULL&VOID IF WORT(OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WIT IN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABA14DONED 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 ageitil.on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described properlyand structure eviewand Inspection
of this project.Owner/Buflder acknowledges submission of Inaccurate information m imd may result in a slop work order or pe re lCn..fcifrp�edglnenI
of such is by signature below: tt�[[�[[rrrrrryyyy 1 YY �C((JJ
OWNER AFFIDAVIT-I certify that I ant exempt fron the requirements of CONTRACTOR'S AFFIDAVIT-I cerhythat I dri ref tl$e des a
t tilew Contractor Registration la RCW 18.27 and am aware of the ordi- contractor in the Stale of Washington and that I am ware of finance
nonce requirements for whiGn this permit is issued and that all work will be requirements regulating the work for wli!421 �, Issued and all
done in conformance therewth. No changes shall be made without first work shall be done in conformance therewith.No ar1g I37i2ade
obtaining approval. without first obtaining approval.
Date �,Y-/3-43 X Cate
r
1=011 OFFICIAL_USE BEYOND THIS POINT
/4 : ,)�
Accepted by Date�� 0 -� Submitta(Amount Due � • 5� Receipt No.
i C(��e p (ii t)t,€i c(,i<•P�t)il�lB; ,� ( frs� ?S,i, i1'�t �.n
Building Department
Coo Group 1"" a Consh.
Planning Department
f _
i Environmental Health Department
' Public Works Department
t Fire Marshal
,
k
(
' Valuation$
1 91 '-s s�aga �l g ar
• « "+9 ".G.Lti ,ti1T r° a l.?°' xa2s8� a e344sr4�".® 'a.Ar.waYue af'li��r"a:,„kklT �e1tlI MXX"Wo'g,
k Building Permit Fee Site Inspection
Plan Review Fee Eli Review Fee
Plumbing & Base Fee Planning Review Fee
Mechanical&Base Fee Olhet
Wood/Gas/Pellet Stove Fee State Fee
Violation Pee Pre-Paid at Submittal
T OT'AL FEES
MASON COUNTY
BUILDING PERMIT
Permit No. ate
fit
Address
Owner
Contractor Reg. #
Job Description
Foundation Footing
Foundation Wall
Below Grade/Slab Insulation
Plumbing Inspection
Mechanical Inspection
Frame Inspection
Insulation Inspection
Wall Board Inspection
Fire Marshal Final (commercial only)
Final Inspection
Applicant Must Call Issued By
427-7262for
Required Inspection POST THIS CARD IN A CONSPICUOUS PLACE
AT THE FRONT OF PREMISES.
This Building NOT To Be Occupied Until Finaled
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APP OV
MASO UI DING I PECT OR Soto l F
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y Group A-3 Panic hardware may be omitted from the Main WO Cxt r rec1�tY`d �t pm
A m Exit Door provided there is a sign "THIS DOOR MUST 6t�W
0 3 REMAIN UNLOCKED DURING BUSINESS HOURS". The
sign shall be in letters not less than 1 inch high, (contrasting
background). UBC 1007.2.5 T�lO � r t�}c`u�rcc� vr�nn
r 3 Aisles shall be a minimum width of 36"where
merchandise or obstructions are placed on one
( t side of the aisle,and/or 44"where obstructions
.q. are placed on both sides. (Req'd for all Group l
c 1 . 0 C j1
a .� M. and assembly occupancies without fixed � Ext 't S(cyMs �' � IIUt`V1�M�Q1t•
0 o U) seating)UBC sec. 1008, 5,4.3.
Exit Signs. Means of egress Exit Signs: When two (2) exists i ire required
identification, illuminated exit signs are from a room or tenant space, exit Bigns must be
required,except in rooms that are
obviously and clearly identifiable as installed in order to clearly indicate the direction
~ Exit Doors. 97 UBC 1003.2.8.2. of egress. When exit signs are rei juired, they
-n O r� shall be illuminated. Illumination hall provide
O Z.
rn ,- op P.H " not less than 5-foot candles at fl r level.
Panic Hardware. Exit doors from Exit doors shall be openable from the
N r, 'r Group A. Occupancies having an
inside without the use of a key or any
•T, c _ occupant load of 50 or more shall not special knowledge or effort. The
( t'/ be provided With a latch or lock unles unlatching of any leaf shall not require
4 G is panic hardware. UBC 97 1007.25 more than one operation. Provide lever
00 operated hardware. UBC 97 1003.3.1.8 h
lJu1 r� r'°OYv�t S 10'tt0.t� hFJt)1Yt � i",. Ir' '
M Provide EXIT Illum(nation of 1 footcandle at
M the floor level anytime the building is u +~
occupied. The power to the fixture shall be Zar
supplied by a separate source where A. c? lc
serving an occupant load of 100 or more. Provide a Sign near the main exit from .
UBC 97 1003.2.9.2 this room stating: u, J.
"Maximu�t Room Capacity: eg
`101 Occupants"
UBC Sec. 1007.2.5
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APPP VE ���� . F '�3'-i
MASON BUILDIN JeCcaah} loan IiFO
C S SUBJECT TO , P
D . FF� `�'-� -y I I rC �cc�
&%up Paic�hardware may be omitted from the Main
Exit Door provided there is a sign "THIS DOOR MUST 3�l�
REMAIN UNLOCKED DURING BUSINESS HOURS". The
sign shall be in letters not less than 1 inch high, (contrasting
background). UBC 1007.2.5 T�AtCf t�$
Aisles shall be a minimum width of 36"whereV- V✓�A@.
!� m merchandise or obstructions are placed on one
I ' 0 N side of the aisle,and/or 44"where obstructions L ,
i�
- m are placed on both sides.(Req'd for all Group EX t I 5 LCi/yls � I lN1'v��rt0��t,D M.and assembly occupancies without fixed l.-
z 3 h seating)UBC Sec. 1008. 5,4.3, i /7 '1 l �I
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G y Exit signs. means of egress identification, illuminated exit signs are Exit signs: When two (2) exists re required
'N SN required, except in rooms that are from a room or tenant space, exit signs must be
obviously and clearly identifiable as installed in order to clearly indicate the direction
m ca Exit Doors. 97 UBC 1003.2.8.2. of egress. When exit signs are re uired, they
shall be illuminated. Illumination shall provide
not less than 5-foot candles at floc r level.
To
�7 Panic Hardware. Exit doors from
� Group A. Exit doors shall be openable from the
p Occupancies having an inside without the use of a key or any
V occupant load of 50 or more shall not special knowledge or effort. The
-' r? be provided with a latch or lock unles unlatching of any leaf shall not require F3
a is panic hardware. UBC 97 1007.25 more than one operation. Provide lever O �,
operated hardware. UBC 97 1003.3.1.8 �' M
adth room r S r 00reA >
W
Provide EXIT Illumination of 1 footcandle at �•' '- .w
the floor level anytime the building is cm
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' v O sa '� ... 1.
'A occupied. The power to the fiMure shall be Bpr CAV eGt pX z w cKa A
o V I supplied by a separate source where W d
a serving an occupant load of 100 or more. Provide a Sign near the main exit from Q
Q UBC 97 1003.2.9.2 this room stating.
"Maximu Room Capacity: a
`101 Occupants" j
UBC Sec. 1007.2.5
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