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Home My WebLink AboutBLD2005-00579 - BLD Application - 4/7/2005 MASON COUNTY PERMIT 1\10. BUILDING PERMIT APPLICATION eJ 426 W. Cedar • P.O. Box 186, Shelton, WA 98584 Shelton (360) 427-9670 • Belfair (360) 275-44 7 • Elma (360) 482-5269 On the web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Company ame It.t g-oxiTspirrytjLt-C Mailing Address • I Mailing Ad ress b; City State Zip Code City . p State 4niA — Zip Code " "x' Phone 't 76 3 Other Ph. Phone -.C' Other Ph. 'g1 Lien/Title Holder I , Contracto Reg. Exp. E mail address 0, E Mail Adi ress La rw lot dq a 1, ; Drivers Lic.# " DOB Drivers Li .# fs''31 d` DOB SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Water System Name of Water System Well Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. 1040 Fire District Legal Description Site Address (Please include street name, street number and city) I t.-o•o LAt4P D Rj :, t Directions to site iv 4► Will timber be cut and sold in parcel preparation?Yes/No ' Is property within 200'of Saltwater Lake River/Cree Pond Wetland Seasonal Runoff Stream Slopes or Bluffs > 15% 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 s !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. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTIO14 X Date. .� Owner/Owners Representative/Contractor indicate which one FOR OFFICIAL USE BEYOND THIS POINT Acc pted by: Date DEPARTMENTAL REVIEW APPROVED DENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Building Permit Fee Site Ins ction Plan Review Fee may. ✓ EH Review Fee Plumbing & Base Fee Planning eview Fee Mechanical & Base fee Other Wood/Gas/Pellet Stove Fee State Fe L ion Fee /V0 /� Pre-Paid 't Submittal tion $ TOTAL F ES MASON COUNTY ' DEPARTMENT OF HEALTH SERVICES I April 16, 2005 PO BOX 1666 Shelton WA 98584 Shelton (360) 427-9670 Fax (360) 427-8442 WARREN OHLSON Elma (360) 482-5269 161 E WOODLAND DRIVE SHELTON WA 98584 Belfair (360) 275-4467 Case No.: BLD2005-00579 Parcel No.:420125100008 Dear Applicant: Your building permit cannot be approved by Mason County Environmental Health until the following are completed and turned in: Report within the last three years from either a septic tar k pumper or an Operation and Maintenance Specialist. Please call me at (360)427-9670, ext. 353 if you have any c jestions. Sincerely, Cindy Waite Environmental Health Mason County Health Services Comments: 4/16/2005 1 of 1 BLD2005-00579 Mason County Dept. of ComiT unity Development Mason County Bldg.3 426 W.Cedar P.O. Box 186 (360)427-967 Local (360)482-5269 Elma Shelton, WA 98584 (360)275-4467 Belfair Notification of Permit Cancellation Permit approved, not Issued July 18, 2007 WARREN OHLSON 161 E WOODLAND DRIVE SHELTON WA 98584 Case No.: BLD2005-00579 Parcel No.: 420125100008 Proiect Description: ADD PARTION WALLS- REC ROOM Dear Applicant: Upon review of our records, the Mason County Permi Assistance Center has identified that your building permit application has be n approved and ready to issue since 01/24/2006. Once approved, permit applications are valid for 6 months. If you intend to obtain this permit, you must make arrangements to do so within ten (10) working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building nspector will make a site visit. In the event that your project has been completed and a permit was never issued, you will be assessed penalties as allowed under Masc n County Title 14 and Mason County Title 15. If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at (360) 427-9670, ext. 284. If you feel that you have recieved this notice in error please contact me. Thankyou for your cooperation. i S incerely, f I Genie McFarland Mason County Department of Community Development July 18, 2007 BLD2005-00579