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HomeMy WebLinkAboutBLD2006-00585 Cancelled MH Space 17 - BLD Application - 4/10/2006 K1.:� I-L.ftQt:�tAtz- FORM MUST BE COMPLETED IN INK MASON COUNTY PERMIT NO. D PLEASE PRESS HARD 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 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMA 10 h Owner f�eso� �►�J Q 5�h�C.v�-�s LLC Company Name_k,-��s "to )c No K Mailing Address (-`ISO �f Bch Mailin Address /65bl L/ f�� �1—E City Lk. ;Q � State LAJ Zip Code C t=' ity State UJ A_ Zip Code9?3$"1 Phone l,O)O19-2463 Other Ph. 3b81 Other Ph. _ Lien/Title Holder Contractor Reg. # SHHS p KS Exp.T2jbko E mail address E Mail Address Drivers Lic. #&jurj 3!y-1 i0d DOB /C—K-66 vers Lic.# DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New tic Existing Septic X Connect to Water System _Name of Water System— Well- Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit Parcel No. o o i Fire District b Legal Description Site Address (Please include street na_ e, stre t r}umber a �S. /4'E ah�eh r d_ / Directions to site Q� d l (�,`�t o k' Will timber be cut and sold in parcel prep ration?Yes Is property wi hin 200' of Saltwater �Lake Flyer/Creek Alo Pond AJ U Wetland Seasonal Runoff a, Stream I Slopes or Bluffs Is this permit submittal the result of a Stop Work 4ofice,jorrection Notice or other enforcement action?Ye TYPE OF JOB - New Add Alt4DP6 . Other,e e� ' RIMARY RESIDENCE ® SEASONAL ❑ Use of Building Der No. of Bedrooms— No. of Bathrooare Footage- 1st Floor2nd Floor 3rd Floor Basement Covered Deck Other Sq. ft. Garage Attached Carport Attached Detached MANUFACTIOED HOMEJNFOR TION'/Make i 'fµjO odeI �� YearQ Len ��_ icI erial NONZ No. of Bedrooms No. of Bathrooms 2 Type of Heat ��� Pfur hase Price�€ y ©a Replacement Unit? tsl No Installer Name Certification No. W�_qk' s-D3YS OWNER /BUILDER Acknowledges submission of i curate information may result in a stop work order or permit revocation. Acknowledgement of such is by signature below. I d lare 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 th ork as proposed in the application. I declare that I have obtained the permission from all the necessary parties. If permission is required fr any easement holder or any other party in interest regarding this application or the work proposed in the application, I have obtained per sion from them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the in ation provided is accurate and grants employees of Mason County access to the above described property and structure for review an spection. This permit/application becomes null & void if work or authorized construction is not commenced within 180 days or if construe n work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INA VITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X /�st Date: y � O n)r/ wners Rep esenta it ntractor (indicbte which one) FOR OFFICIAL USE BEYOND T IS POINT Accepted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Fire Marshal FEES Building Permit Fee Site Ins ection Plan Review Fee EH Review Fee Plumbing & Base Fee Planninq Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES