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HomeMy WebLinkAboutBLD2009-00068 Revised Bulkhead Final - BLD Permit / Conditions - 5/8/2009 Request To Revise An' prove C?irAZ I K M,7- Permit Number: BLD200 _ - Nam ►. v e Parcel Number - - Phone i,-0 F 7 9 i Project Address p _ 4 7,,vq Mailing Address 61 x_/ <<,l/ piac e Please provide a complete, detailed description of the proposed revisions to,the approved plans: ✓!S i c / Y> 0 y A s4c A4.fPs 4 u�2 ' •v Are two sets of the revised plans or addendum indicating the changes included? L✓J Yes ❑ No Are the approved site plans included? ❑ Yes ©'"No Are the revisions clearly and accurately identified on the plans or addendum? Wes ❑ No Does the plan contain an engineer's or architect's lateral or vertical analysis.? a` es ❑ No If Yes, Has the engineer or architect approved this revision? 2 c's ❑ No Is a stamped and signed approval included with this request? a/Yes ❑ No (Note:No structural changes to a"designed„plan will be approved without the written consent of the engineer and/or architect of record.) Does the proposed revision modify the footprint or location of the structure? ❑ Yes 21 No If Yes, Is a revised site plan, with all new setback dimensions included with this request? ❑ Yes ❑ No Additional Information: Applicant's signature .f Date: 3 /-,:,,, e7 Office Use Only Received by: Date Sent Assigned To Approved By Date B Original Valuation: $ � T YYZ( 5Additional Valuation: $ r ( Sq.Ft. x$�_ $ t Sq.Ft. x$ $ Total New Valuation $ Additional Fees: ❑ P.W. Additional Planning Dept. $ Additional Plan Review $ .3 Additional Conditions/Comments: Additional Building Permit $ Additional Plumbing $ Additional Mechanical $ Additional E.H. Dept. $ Other $ Total Amount Due: $ Amount To Be Paid p-Front$ r < m CL v O` 0 0 v m C (D Z v c n r m O v a0 -i m m D OD c c ° c O D N 0 C n 3 m CD m �� � mmm0 ' (M cn = = m � 00 -i � zo � o N x. O x �' co CD ° v 3 z =� mm � z U) Z �, v vWcn z � � xx fD D o (D O O cn ' ?! cn 3 n - r- � rn -� o _ o OD DNS _ c) O m m 3 (D m c:) z ° Z p N 0 v C N C ;u U) 0m0 00 O v o C/) orr- nm cn n C 00 Q : (D = O � O0 00 (C)Q- (D zm Z p Z 00 � 0 N � ZZ � 0- OC rn W � ° o wv o � � m a Q a �u � �. Z o r (n � (D n. 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Type of Insp. Fail Date Date Done By Comments W a f"� 5 � Dc[ K 6� [�Oi s v a 8 CD a cc N O 3 2. ri nt afro nMason County DMS ( MASON COUNTY PERMIT NO. 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 q--APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company Name Mailing Address Mailing Address PR. City State Zip Code City41Q— u�►�} State — Zip Code!,- C'-,;" Phone Other Ph. Phone - Other Ph. Lien/Title Holder Contractor Reg. l l' Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers Lic. # DOB SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septi Existing Septic Connect to Water System Name of Water System 's — Well Sewer System Name of Sewer System PARCEL INFORMATION - 12 Digit 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 property within 200' of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No TYPE OF JOB - New Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building Describe Work No. of Bedrooms--No. of Bathrooms Square Footage- 1 st Floor 2nd Floor 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 work order or permit revocation. Acknowledgement 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 them to apply for this permit and conduct the work proposed. The owner or agent on owners behalf, represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure for review and inspection. This permit/application becomes null &void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OF WORK IS BY MEANS OFA PROGRESS INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THEAPPLICATION. X I ,., . >l�/,6° Date: Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by " D a t DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department 6 7 — e Planning Department AA �� i Environmental Health Department /vC) Fire Marshal G2/YG� moo✓ FEES 7 / O uildinq Permit Fee Site Inspection Ian Review Fee - EH Review Fee Plumbing & Base Fee Plannin Review Fee Mechanical & Base fee Other Wood /Gas/ Pellet Stove Fee State Fee Violation Fee a G Pre-Paid at Submittal Valuation $ (�Q TOTAL FEES