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HomeMy WebLinkAboutCOM2008-00100 Tullys Kiosk - COM Permit / Conditions - 8/18/2008 v MASON COUNTY PERMIT N BUILDING PERMIT APPLICATION 0 Dt/ OD 426 W. Cedar a P.O. Box 186,Shelton, WA 98584 Shelton (360) 427-9670•Belfair(360) 275-4467• Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT I F0RMA N OR Owner ( 1 1 Company Name Mailin Address � � Mailin Address Ci fate Zip Code City Stet Zip Phone `Z.t O her Ph. Phone �Z-� Other Ph. Lien/Title Holder Ap Contractor Reg.# Exp. - E mail address E Mail Address ��" Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic. Existing Septic Connect to Water System Name of Water System 'r%LI Well___,Water System Name of Water System PARCEL INF AT ON-12 Digit Parcel No Fire is Legal Description G Site Address(Please include street name, street number and city) 6 Directions to site Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond Wetland ...Seasonal Runoff Stream Slopes or Bluffs > 15% Is this pwmft a6mlIttal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB-New Add Alt Repair Other P IMARY ESIDENCE �8 AL Use of Building; Describe Work No. of Bedrooms o. of Bathrooms Square Footage- 1 st FloorjdZ,IAJ 2nd Floor vf ._ 3rd Floor Basement Deck Covered Deck Other Sq.ft.- Garage - Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make 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. OIMMR/BLXDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Acikrowlet esai t of. such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further decla permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the nec required from any easement holder or any other party in interest regarding this application or the work proposed in the application,t have' permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,repatlon provided Is oyees of Mason County access to the above described property and structure for revi PR W I MEANS OF A PROGRESS INSPECTION. Date;t I 19 'a� MASON COUNTY - -- Owner ers esentative! ra r indicate which one FOR OFFICIAL USE BEYOND IS POINT Accepted by Da DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Y 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 Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES MASON COUNTY PERMIT N BUILDING PERMIT APPLICATION COI 0 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670- Belfair(360) 275-4467- Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANI I FORMA N CONTRACTOR IN O ATIO Owner i 7 I Company Name Mailing Address i AAr IGO Mailin Address ar Ci tate Zip Code City '7 State "nor Zip Phone bZf, Other Ph. Phone - WL Other Ph. L� Lien/Title Holder Contractor Reg. # Exp. E mail address E Mail Address6eAla w Q AvKgq ►a^ Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic Connect to Water System Name of Water System 41 in 04 Well Water System Name of Water System PARCEL INFORMATION-12 Digit Parcel No Fire is rjgt Legal Description Z Site Address(Please include street name,street number and city) (o Directions to site Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is ttds pwmft submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB-New del Alt Repair Other PRIMARY ESIDENCE F1SE ONAL rl Use of BuiidingZ'A,VV Describe Work No. of Bedrooms -- T. of Bathrooms Square Footage- 1 st Floor 2nd Floor Z- 3rd Floor Basement Deck Covered Deck Other Sq.ft. Gars Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION-Make 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop work order or permit revocation.Adutowledgement of such is by sire below.I declare that I am the owner,owners legal representative,or the contractor.I furtherdedarAMlI' I� permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the ne ril required from any easement holder or any other party in interest regarding this application or the work proposed in the application,I have abWned permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, h�t p provided is a oyees of Mason County access to the above described Property and stricture forrs�vs�vd ins �l n PR W IS MEANS OF A PROGRESS INSPECTION. Date;.' S MASON COUNTY E wner ners a esentative/ trac r indicate which one FOR OFFICIAL USE BEYOND HIS POINT Accepted by Da DEPARTMENTAL REVIEW APAROVED DENIED NOTES Building Department Q Planning Department y I Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee cR/ EH Review Fee Plumbing&Base Fee 4e*F AO -2,3. /d Planning Review Fee Mechanical&Base fee �� Other Wood/Gas/Pellet tove Fee State Fee Violation Fee AIOUL Pre-Paid at Submittal Valuation$ TOTAL FEES I MASON COUNTY PERMIT N BUILDING PERMIT APPLICATION OD 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670-Belfair(360) 275-4467- Elma (360) 482-5269 On the web www.co.mason.wa.us APPLIC , i FORMA N CONTRACTORN RMATIO Owner ( 7 Company Name C +J Mailing Address Mailing Address Ci tate Zip Code sty StateZip e Phone 6'W O her Ph. Phone - 1•Z- Other Ph. Lien!Tale Holder Contractor Reg.# Exp. - E mail address E Mail Address N ��" Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System CA N41`!g1 Well Water System Name of Water System PARCEL INFOR TION-12 Digit Parcel No � Fire is rj�t Legal Description Z Site Address(Please include street name,street number and city) 6 Directions to site Will timber be cut and sold in parcel preparation?Yes/ Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% Is this rmlt submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB-New dd Alt Repair Other P%p2nd DENCE SEASONAL Use of Building Describe Work No. of Bedrooms -- o. of Bathrooms � Square Footage- 1st Floor Floor Z- 3rd Floor Basement Deck , Covered Deck Other Sq.ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION -Make 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. OWNER/BUILDER Acknowledges submission of inaccurate information may result in a stop walk order or permit revocation.Advrowledgement of such is by signature below.I declare that I am the owner,owners legal representative,or the contractor.I further declai is permit and to do the work as proposed in the application.I declare that I have obtained the permission from all the nec�I�ttieL7f required from any easement holder or any other party in interest regarding this application or the work proposed in the applcation,I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf,rep li' ption go a oyees of Mason County access to the above described property and structure for �nn'"''"'W MEANS OF A PROGRESS INSPECTION. MASON COUNTY Date" 'p�ners esentative/ ra r Indic which one FOR OFFICIAL USE BEYOND IS POINT Accepted by Da DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department ja=&Py Environmental Health Department Iy p Public Works Department Fire Marshal FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Revi w Fee Mechanical&Base fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation$ TOTAL FEES FORM MUST BE COMPLETED IN INK PERMIT NO. PLEASE PRESS HARD MASON COUNTY PLUMBINGNECHANICAL PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360)427-g�7 •Be air((360)275-4467•Elma(360)482-5269 On the we%wJuw.co.mason.wa.us APPLICANT F RMATION ' CONTRACTOR TIO Owner Company Name Mailing Andres Maili g Addres City Mate, ip Code City fate Zip Code Phoneffi i Other Ph. Phone r Ph. Lien/Title Holder Contractor Reg Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 it Par el o. Fire District Legal Description Site Address (Please include street name, street number and city) Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff—Stream—Slopes or Bluffs > 15% TYPE OF JOB- New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1st Floor 2nd Floor Basement Gara Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric— LPG_ Natural Gas_ Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Ao-.40f�j .�— Gas Outlets Kithen Sinks ��,, py Wood/Gas/PelletStove Dishwasher ``„"sue_ Kitchen Exhaust Hood Hosebibs J Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MEC ANICAL 0VMVER/BULDER Advv*Wges submission of inaccurate information may result in a stop work order or permit revocation.Acl xwAedgenw t 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.0 permission is required from any easement holder or ary outer party in Interest regarding this application or the work proposed in the application,I have obtained pep from for this pemtit and conduct the work proposed. The owner or agent on owners behalf,represents that the information o Me f son County access to the above described property and stricture for review and inspection. BY MEANS OF A PROGRESS INSPE f Date: r/Owners R tatl rector (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld PdReceipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ ro Type Constr.— Planning De rtment Environmental Health Department FEES Plumbina&Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES MASON C UNTY PERMIT NO. PLUMBINGNECHANIC PERMIT APPLICATION 426 W.Cedar•P.O.Box 186, Shelton,WA 98584 Shelton (360)427-�67% Belfair(360)275-4467•Elma(360)482-5269 n t e weDb www.co.mason.wa.us APPLICANT INF-ORMATION� CONTRACTOR INFOR MATION Owner "` { r Company Name Mailing Adclres Mailing Address ' City 1AAM tate_ _C= 'Zip Code 21 '` City # k.", �..V— State- 41 Zip Cod Oth�—er Ph. Phone - her Ph. Lien/Title Holder + ` - Contractor Reg. Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION- 12 D.Igit Parcel No. Fire District Legal Description Site Address (Please include street name, street number and city) ` Directions to site Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% TYPE OF JOB - New Add Alt Repair Other Use of Building Location of Fixtures/Units- 1st Floor 2nd Floor. Basement Garage—Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Type of Fixture No. of Fixtures Fees Fuel Type:Electric__ LPC Natural Ga$_ Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Hea um s Showers s Spo VentFan Water Heater Propane Tank Clothes Washer Gas Outlets Kithen Sinks `� Wood/Gas/Pellet Stove r Kitchen Exhaust Hood Ho ebibs er Dryer Vent Dishwash Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL GMN EIVBULDER Adatowledges submission of inaccurate information may result in a stop work order or permit revocation.Acivawledgement 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 to, for this permit and conduct the work proposed. The owner or agent on owners behalf,represents that the information provided of Mason County access to the above described property and structure for review and irtspe bw. RPQR; F W IS BY MEANS OF A PROGRESS INSPECTION. Date: � — r/Owners Rep sentative ontractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd Ck# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Occ Group-Type Group—Type Constr. Planning Department Environmental Health Departmentl 6i v lop F FEES Oo Plumbing&Base Fee Site Inspection Mechanical&Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEE WOODMAN CONSTRUCTION, INC. 3 Lake Bellevue Drive, Suite 201 Bellevue,Washington 98005 Phone#(425)454-3621 Fax#(425)454-6918 September 2, 2008 Mason County 426 W. Cedar Street Shelton, WA 98584 RE: Tullys Kiosk in Safeway- Belfair 23961 State Route 3, Suite B Belfair, WA 98 To whom it may concern, Woodman Construction has bid construction of the above referenced project and the building valuation for installation of the Tullys kiosk is $13,400.00 (thirteen- thousand four-hundred dollars). Woodman Construction, Inc.'s Washington State Contractor's License is WOODMC116706, which expires 1-5-09. Please inform us at your earliest convenience of the remaining permit fee balance and we will come to the City immediately to pick up the construction permit. If you have any questions or comments, please contact me any time at 425-454-3621. Respectfully submitted, Woodman Construction, Inc. Lachlan Foss, Project Manager N C!� o ,y n 10'-114" C m r DCD O -u M m(n -� rrn 0 0 o Cf) r� 9D VJ _ n c C) n r D\ �' O r 0 tU o —n -p• Ln Q z o0 O \ p D / W mz zIn \ vz rn rn m ca o > 3'-3" _ D O Fn z 0 2'-9" v) N N W O o I I O O Q v D vw s f - - I =� = N ao v_ Z M�'�l Np ( / C T O�Z CD (A \ D D N �in I I v v>c w II — cs Fl an I ` m it I ot N N s 3 C� � m 2 �n np AC -p_0Dm 2 �� m r0D \ Z O T7 v m x� g -m v, v II o mx N z�O Z0 rn C)i r m -n �z Z zz m Z AW 1 8 LUU8 3" 39_0„ 5'-34» 2,_8» 0OMASON COON-rX O CF) 00 o Cn _ D ---� -n c m r r D �-� '< 8'-6" `+ 0 7'-6" 0 n 4'-6" N O Cfl D n I w rn rn m //O VJ Z� Qp� Z ( rn Fn r k O n N Irt m D r' N m C7 fn i o o n N < li m O wz r-N F- > nN m D c Z 7000 —� n N :O i ;o O 0 z CA rn m � rn N rn m � m � -n (pp7 D ;o D r 0 N C7 Z '�- Iq Z O --1 Z n C) Z � \ w a D � 6- t2'-10" 3'-6" m o m � N 1 3'-9" m D^ 5-0" a G) 0 m c) 0 o RECEIVED CD m 00 AUG 18 2008 MASON COUNTY N C/) O D —1 n cm rr ` owmo Zyrp DmNi 7,? yog ,iz � Zrn rn v o;o VJ y.�„ _ p v r*t > > m TI -P CD � r m i-,-, m m O n Cn D r r'z ��vo rnO a � z ; _ I I / F91 � �0 � UD z � c�t m� X vca z co m o � n� o b D < Mam No OD m FIEI \ No � <m ;K " D ii / II %> o cA N I -o n �mcn > p O .. Pi G y D m - 0 0m m �W P 0 � p 4` cm 1� v x cn y^ O � N n N 55 ;o m o w Dry a w D < 4 o AUG 8 7oo8 m MASON COUNTY N . . O � _ D c- m c r- r- y T ._..__ TT -....__.. ZO C n ZO ON t r r l f m T , 1 I OnW t t I Q Mmv m mn i L-- J AO m o0 � C r - I �O I- D -i�7 - a m O -0 i I .Zi O —J v m ��^^ z N o U) 0 � O CA _0 C M v0 1 mZ 7C Nam\ r III r-m D -G Cl Z N 8'-4",,, CA o i - _ D gzo 23 > n OD BOND �N Xm� r D D C '*1 I!l -0 -0 Z a N�.{{ v0 .:i: C 1 580 D ao=o m rZ o M x NNt I- v o z NN o n O =Zr- M O -� v = REE,�► po C D 'n O AUG 18 2008 O 00 MASON COUNTY oC/) _ ?> c m r � r y Cn O � N -n -P w m N 1 1 cn N rn O vNi -� � � 3'-0" r 1 -16 � z � � _CID Z �_ D n g D N m � D rn N fm r w � O �D DN mCl)O Q(7 r O m Z C F-4 D zm C zL N �o D OCT--) N N O Z -o v D O O r rn S � Sr S � !n � z � z z � m0 m � m � r n D � 1� 'v nD C7D � D r D� O N O Cl) Z ; Z Z C) -1 Z -� m -4 � m® X0 z D 1 D = r-4 F-+ N w a It 5'-0" II c Z T �m V ~ v N m DCD V J m o cn O o RECEIVED o AUG 18 2008 m 00 MASON COUNTY N Cn O � CA 5'-0» � m C 3'-9» 3'-6» r C A (n V f � Z © r��� 2—, gym, 1 1 O I v N -� m m TI < C D < D m -,16 , 6 v w m 0 — n co-) o z r Z N OOD /\ r' r O n tNi> p w O > aN m o O z a � o n z -P 8'-6» 7'_6» w N @ cn m 6'-8 N � r m Z m � mSo m � N m O C m cn _ CD D D z r m 0 r O 0 II 0 o RECEIVED 4'-6» m Oo AUG 18 2008 MASON COUNTY MASON COUNTY DEPARTMENT OF HEALTH SERVICES August 29, 2008 PO BOX 1666 Shelton WA 98584 Shelton (360)427-9670 Fax (360)427-8442 SAFEWAY#1571 Elma (360)482-5269 1371 OAKLAND BLVD STE 200 WALNUT CREEK WA 94596 Belfair (360)275-4467 Case No.: COM2008-00100 Parcel No-:123294100010 Dear Applicant: Your building permit will not be approved by Mason County Public Health until the following items are completed and received in our office. Application for water adequacy completed and signed by the water system manager. Please see comments at the end of this letter. Please call me at(360)427-9670, ext. 353 if you have any questions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: Need approval from the State Department of Health. Contact Richard Benson at 509-456-6177. 8129/2008 1 of 1 COM2008-00100 Look Up a Contractor,Electrician,Plumber or Elevator Professional License Detail Page 1 of 4 Informadon in Spanish I Topic Index I Contact Info I C Home Safety Claims e Insurance Workplace Rights Trades B Licensing ..................... .......................................... ...................................................... Find a Law(RCW)or Rule�1A/AC) ': Get a form or publication Return to List > Start a New Search > El Printer friendly General/Specialty Contractor A business registered as a construction contractor with L&I to perform construction work within the scope of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment of account and carry general liability insurance. Business and Licensing Information Verify Workers' Comp Premium Status Check for Dept. of Revenue Account Name WOODMAN CONSTRUCTION INC UBI No, 600529580 Phone No. (425) 454-3621 Status ACTIVE Address 3 LAKE BELLEVUE DR 201 License No. WOODMC116706 Suite/Apt. License Type . CONSTRUCTION CONTRACTOR City BELLEVUE Effective Date 9/26/1984 State WA Expiration Date 1/5/2009 Zip 98005 Suspend Date County KING Licenses WOODMC*172ML Business Type CORPORATION Next License Parent Associated Company License Specialty 1 GENERAL Specialty 2 UNUSED Business Owner Information Hide All Name Role Effective Date Expiration Date WOODMAN, PETER J 01/01/1980 WOODMAN, MARTHA C 01/01/1980 https://fortress.wa.gov/lni/bbip/Detail.aspx?License=W OODMCI16706 9/22/2008 O D T K (n m -I 0 2�p d m o x c m O D o o o dl to D o -n0 D Zm O 21 mn 0 W Z -n � CO) w �! 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