HomeMy WebLinkAboutBLD2012-00052 Replace Bulkhead Final - BLD Inspections - 8/9/2012 40 , *. I
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Date By Data By DECKS
FRAMING walls Date By
Date By Data By PROPANE TANKS
PLUMBING vault Date By
Date By OTHER
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Date By Date By Date By
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MASON COUNTY PERMIT N0bjj �U�' %0\
BUILDING PERMIT APPLICATION
426 W. Cedar• P.O. Box 186, Shelton, WA 98584 i
Shelton (360) 427-9670 •Belfair (360) 275-4467 • Elma (360) 482-5269
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner K • Company Names;
Mailing Address P1' C�-X LLLi Mailing Address P�
City 17-AFl y i tr W" Stated Zip Code `SS 1_` C r75 City L-1-"iJ State -,)A Zip Code 1�71 . .S 2-
Phone 2��"'��3�''4"?� Other Ph. Phone 3h o- 1_7i- Other Ph.
Lien/Title Holder 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_X,
Connect to Water System Name of Water System
Well Water System Name of Water System
PARCEL INFORMATION - 12 Digit Parcel Flo 1 L i cis 7=- �5 �: t Fire District
Legal Description nZi-D et= , CVj /1s" Ls,'j` it c►= SP Zvice'C?-) S 331 �LZ
Site Address (Please include street name,street number and city) Z 5- c 7,2 t �+ Is -:� >d ►Z� N
Directions to site :�:(LLtH TO �rZ�r G�L �1/iE,✓ .��' VT J C-_(40Z - "z
ct iL _ f ''✓'' %,e ►trL — i ,Se=
Will timber be cut and sold in parcel preparation?Yes o_) �'� �dr t�•'T.
Is property within 200'of Saltwater _Lake - River/Creek Pond
Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% �C
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 RESIDENCEA SEASONAL ❑
Use of Building Describe Work Qe i'5%• LAC- k LT1a 02,2c,2::-r�
No. of Bedrooms No_ of Bathrooms Square Footage- 1st Floor 2nd Floor ►; i-i✓Ne.YlU
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.
01NNER/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 accura and grants employees of Mason County access to the above described property and stricture for review and inspection.
PR F F C NUAIION OF WORK IS BY MEANS OF A PROGRESS INSPECTION.
X 1� „°� �� z� 0 :,.V . 0.0. Date: //3/0 Z-/ L
Owner/Owners Re resentativ Contractor indicate which one
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date -3j o�@
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department L 1. /L L*4 1c ';,5
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
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
426 W. CEDAR ST.
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APPROVED
ASON COUNTY DCD PLANNING 426 CEDAR ST
S06 S N REQUIRED TO BE ON SITE
BY CHANG JECT TO APPROVAL PLANNING:
ALL SETBACKS ARE MEASURED
FROM THE FURTHEST
OJECTION OF THE BUILDING
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