HomeMy WebLinkAboutBLD2003-00341 - BLD Permit / Conditions - 3/28/2003 (4)MASON COUNTY
BUILDING PERMIT APPLICATION
FERMI NO BLD .3 (.,'• "
as w ONMOP.O. Ear 86. Sharer WA gess(
tern DOTI 427-9670 Datlr 13E01 2S4467 Elnr. l3rD)4D-5.'Ma S. (pa) 4434E068
On I. Web w.* w.n. 0 wa.w
APPLICANT INFORMATION
Ownr -
CONTRACTOR NFORMATION
Contractor Nemo
Mang Address i..a/I yy sf✓c Ir, S fair
Mang Address
ay Lakrtpcne/ SMMfj}l31p Cal 9R49A
Cry Siam Zap Coda
Pnoe ( C 3 V nil' it nipsPIL U)
PTA ( ) other Ph. (__-)
Lientlige Hate *1 A
Contractor Reta ED•_JJ
E-ma Address
E-rnae Mdaa
SEPT CAVATER SYSTEM INFORMATION . Como to New Sepik Eagles Septic t— Cared to sewer
Symem_ Name of sever System Wel I— Wear Syeem
Name or Water Syflm
PARCEL INFORMATON- 12 digit Tax Panel NO, 5170 Y /?(e 1 0649, Fire Maki
Legal ( >1 T of
Site ,bait mat net mews ere city) N'%/ (N wx411A , - ftAl%r d.
Oredips k.M Y _ ,. .. 'r '( - ,.-\ N .. \ \. \.) . ‘ .,4 %l—
...
WI timber be aA and sold to parcel p..,. n9 (Yee/NO) Al (.1
Lake ay.r,Oeek Pats Waging Seras Runts Sewn
Slopes or Milk
PERMMENT RESIDENCE CI SEASONAL RESIDENCES.
TYPE OF JOB -Nam Add AA Rope 1/ tether Mee M BYIIWng
Is tilts penal submittal the rank ol a Sip Wbrk Na0e. Correction
Desoto Wok '--,:- • •.'iiA,eL
Pl@da or other ertWMlea anon? (yea14o)
No. of Badman,_ No. a BeEaSWAM
aoa SWAFOOTAGE • lit Flea. 3 ?se 2e Rea
3.0 Floor Loll /4 RI Bs n n Deli Ole MF IL
Grape Machete Daec ed ORM Aached Oeteled
MOBILE HOME MFORMATlN - Make Model Moe& Yaw
Length 1Wah 9NM M. No. of Bedroom No. of Batrocn.
Try, of Nat Purchase Prin $ Replacement Ikt? (Yee/No)
IrsWle. Name Ceretaen No.
NOTICE: THIS PERMt BECOMES MAL4 VOeD a WON OR CONSTRUCT)ON
CONSTRUCTION WORN IS SUSPENDED 011 ABANDONED FOR A PERCO
PROOF OF CONTINUATION OF WO1l( O BY MEANS OF A PROGRESS
mammal proviee stoma and weld employees d Mani Cantyamra
clew promo OMII.9YNer actiowleOps Mbneevl al namrr . YMMpn
d arch a by eignarre before
OWNER AFFIDAVIT . I err* to tan exMrpl Run the ep+keneas ol
We Caarm Repw'eroo RCW
AUT WR2ED IS NOT COMMENCED WITHIN ha PAYS OR IF
OF la OATS AT ANY TTE M1ER THE WORN IS COMMENCED.
INSPECTION. The
owner a soft on paned Whet. .gwrS tat to
at1eemcee dwabed wady Ind whoa, formless-9 arpbon
may revue In a top whit cede. a pewit wrocialon.Atioaraeclonera
CONTRACTORS AFFIDAVIT .I IS l
wily ern currently repel--d we
mwata n M Ram 0WMkpbn Its fret tan swore efts o wioe
law 1827 ea am aware of Vie cnx-
nonce recOnelwd, for much Pm 4 three
pane Skied rd oat ale ragnrrrede wawa ere rah b Wlph It peso* le Seed eel al
lode it t in tNewm No a to del
a gn *WI nude wi,w*
eteMeaga{pwM.
X id ♦i. Dre
work toe a dale in contimmx• brae NO Wimps mall be node
fro
keno maYnp,ryarel,
%( Date
Mcep1so by
FOR OFFICIAL USE BEYOND THIS POINT
Date
Submittal Amount Due ' Rpeyt PR.
fDOMRIYMITAL REVIEW
APPROVED
DOMED.'.
- -
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err
Wang Depatnerrc
Doc Group Type Cons
Raring Department\
r—V/ S ,C. `'r
EnhoreentM Heath DepMaea
. 4Cie.. L-4.;t
r{.Sa,<c,Z.•.-
Putt Wale Dpenet
Ara Marshal
.w wal e
Blkalp Pant Fee
SR INP,Nm
Plan RSew Fee
DI Reeler Fee
Plumbing $ Bea Fee
Plwilg Re va Fee
MahWol
& Bee Fee
Other
Woo Ga6PMS Sege Fes
Bite Fee
VIIIIMbn Fee
Re-Pald el SVaaal
( )
.-..-__
TOTAL FEES