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Home My WebLink AboutBLD2009-00096 SFR - BLD Application - 2/13/2009 MASON CC)Ll4TY PERMIT NO. BUILDING PERMIT APPLICATIONJ� 426 W. Cedar- P.O. Box 186, Shelton, WA 98584 Shelton - Belfair (360) 275-4467 - Elma (360) 482-5269 On t web www.co.mason.wa.us APPLICANT INFORMAAbN CONTRACTOR INFORMATION Owner Company Name Mailing Address / fir. Mailing Address City State &z/1 Zip Code"4k3 - City State Zip Code Phone-7 - Other Ph. Phone Other Ph. Lien/Title Holder AL Contractor Reg. # Exp. E mail address- E Mail Address Drivers Lic.# N6l3A Drivers Lic.# DOB SEPTIC /WATER SYSTEM RMATION onnect t ew S tic Ex_isting Septic Connect to Water System X me of System Well Sewer Syste a of ewejl^ste ' PARCEL INFORMATION - 12 Digit Parcel No. .. - Fire District Legal Description Site Address (Please include street name, street number and ci Directions to site Y Ay4 122-01 % F Will timber be cut and sold in parcel tion? es property within 200' of aaltwat Lake �N ,,---- Iseek _Pond WetlandSeasonal R off Strea or Bluffs 15% Is this permit submittal the result of a Stop Work Notice,C rrection Notice or other enforcement action?Yes/No TYPE OF JOB -,k4ew Add-- Repair Ot r I ENCE ❑ SEASONAL ❑ Use of Building ,Describ Y11ork No. of Bedroomq No. of Bathroom Square Footag 2nd Floor 3rd Floor asement Deck— Covered Dec ther Sq. ft. ttache etached Carport Attached Detached Garage qn2 MANUFACTURED HO FORMAT ON - Make Model Year Length Width Serial No. No. of toms No of Bathrooms Type of Heat Purchase Price $ Replacemen nit? Yes/ No Installer Name Certification No. OWNER/BUILDER Acknowledges submissigti of inaccurate inforrriagon may result in a stop work order r rmit revocation. Acknowledgement of such is by signature below. I declare that I am tlA owner, owners legal representativo r the contractor. I further declare that I am entitled to receive this permit and to do the work pro6hholder n the application. I declare th r ave obtained the permission from all the necessary parties. If permission is required from a easem or any other party in inter st regardin this application or the work proposed in the application, I have obtained permissi from the ja is permit and conduct sed. The owner or agent on owners behalf, represents that the informaticn providedrategrants em loyees o ason County cess to the ove described property and structure for review and inspection. This permit/applin becomej null & i ork or auth`brized conslction is not commenced within 180 days or if constructi work is suspended for a pe od of 180 day . PRO OF COMTNUATlON OF W,61IS BY MEANS OFA PROGRESS INSPECTION.INAC7MTY OF THIS PERMIT APP ATION OF 180 DAYS W L INVALIDATE THEAPPI,CATION. X Date: �-�- Owner/Owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT cepted y: Dat DEPARTMENTAL REVIEW APPROVED DENIED NOTE Building Department } la Planning Department �1 Environmental Health Department �7 ��..• �� Fire Marshal FEES Building Permit Fee 1 30, Site Inspection Plan Review Fee Ioip/ EH Review Fee Plumbing & Base Fee ? / y Y ?0 Pianninq Review Fee Mechanical & Base fee - y Z 3 '0 Other Wood /Gas/ Pellet Stove Fee K 73- G State Fee S� Violation Fee ' 0. 0 Pre-Paid at Submittal Valuation $ TOTAL FEES MASON COUNTY PERMIT NO. PLUMBING/MECHANICAL 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 INFORMATION i!/ f�i'Yl'yl/L�7 JlJ Company Name Mai Adiress FL. 13c-)4/75- Mailing Address Ca11 in-.-1-L Statei4,/� Zip Code �/fS3S s —_ City Mate Zip Code Phone '�SL'T�'�/�rZ-34s;/ Other Ph. Phone -- Other Ph. Lien/Title Holder Contractor Reg.4 Exp. E mail address E Mail Address Drivers Lic.# DOB Drivers L-ic.# DOB SEPTIC INFORMATION - Connect to New Septic Existing Septic. Connect to 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 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_ LPG Natural Gas_ Heat Pump_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace 4 Bath Tubs _ Heatpumps Showers — _ Spot Vent Fan Water Heater �' Propane Tank f Clothes Washer j Gas Outlets / Kithen Sinks _ Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood I Hosebibs Dryer Vent l Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OVVNER/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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. X Date: Owner/Owners Representative/Contractor (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 Constr. Planning Department Environmental Health Department FEES Plumbing & Base Fee Site Inspection Mechanical & Base fee UFC Plan Review Fee Wood/Gas/Pellet Stove Fee Other Violation Fee TOTAL FEES