HomeMy WebLinkAboutBLD2000-00171 Detached Garage - BLD Application - 2/22/2000 (D o
PERMIT NO.: BL
MASON COUNTY ZZ
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 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Rra-b Axl$t1elc Lt Contractor Name'1 bLytn#Pol)" POST FMPF 1150bt►Ir
Mailing Address logo W. IpAlfrutj 'TRML4 'brLlue Mailing Address I(v 21
City �- t+C-L T ON State_JA Zip Code ` 81'SA( City kytifr wool) State WA Zip Code4IR 37
Phone(5g o )LI3;L-L?A41Other Ph.( -- ) — Ph.(S op ) 624-1552 Other Ph.( A4.25 );Sq-Al 17
Lien/Title Holder b/A Contractor Re #ToWN ePF 099 LT
Address N 1J) Expiration_/ 3o / 00
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic_W p Existing eptic�o Connect to Sewer
I Systemo Name of Sewer System Well V Water System H 1A Name of
Water System TOIL IC-- TALL 'TiA-6 L 0?0,
PARCEL INFORMATION-12 digit Tax Parcel N9. N10o $ / 9 / 9 oo&I Z Fire District
Legal Description 7M4-TS fqF Sugytj BSI ISo Tp+4 or SP *=IC
Site Address(Please include street name, street number and city)1014 o 10 1 -V -TRAILS DRID K Ir LT AN
Directions to site t-3u-+ A.1 jxoaa xaxb _ IuGST off 'bmTeii - tic- lLog7t To r.N 119N 1TI=
Nauss u) T0.1rk t ASO &At �M TROVANe TP104K ON Ilk tto WT
Will timber be cut and sold in parcel preparation? (Yes/No)k_
Is your property within 200' of the following: Body of Water (Name) W/A Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work FRE4T A 'hoST r-RAUM &ARAMs W 1TN0uT PLUN'bIN& - V ETAe—Hel)
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement Deck Other sq. ft.
Garage Attached Detached_Carport Attached Detached
MOBILE HOME INFORMATION-Make to 1% Model 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.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF
CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED.
PROOF OF CONTINUATION OF WORK IS BY MEAAS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the
information provided is accurate and grants employees of Mason County access to the above described property and structures for review and
inspection of this project. Acknowledgment of such is by signature below:
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-]certify that I am currently registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this permit is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. first obtaining prova
X Date X Date O
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Dat*2 //Submittal Amount Due X 66 Receipt No. gb4=
DEPARTMENTAL REVIEW: APPRovl=p D Ni D Cc3fVDITaON coDES
Building Department Nlr3
Occ Group Type Constr. S bwo
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
.......F
Building Permit Fee t 1 5 Site Inspection
Plan Review Fee UFC Plan Review Fee
PLAJ
Plumbing & Base Fee Public Works Review Fee
Mechanical & Base Fee - Other
ST�� y ,sv
Wood/Gas/Pellet Stove Fee - Other
Violation Fee Pre Paid at Submittal ( L Li ��O.:.........................
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