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Home My WebLink AboutBLD2002-00722 Addition and Replace Garage - BLD Application - 5/31/2002 PERMIT NO.: BLD`)CiJIJV`�'CJ��i,7�/` MASON COUNTY .I BUILDIN ERMIT APPLICATION 3 426 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 Contractor Name Mailing Address Mailing Address City State Zip Code City State Zip Code Phone( Other Ph.(____) Ph.( ) 73 60ther Ph.(...) Lien/Title Holder Contractor Reg. # ld u s ETc-i o i&o 2. AddressExpiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well; Water System Name of Water Systern PARCEL INFORMATION-12 digit Tax Parcel No. 3 2 -2 3 3 / .S"o if Fire District ' —r_, Legal DescriptionA)f +►&4 port-;.. of rtic E 9y41 (4 of -M4<w/ 2gy.12 f4 afCovt.L.+$, S« 33, rw., ,�;� '2z Nr ,Z 1 W r1 Site Address(Please include street name, street number/and city) 4 P43 14, t--« l o G t G$1#p,, Lod Directions to site J`rmn At.I+pr►* $ruck d&Ic Rd. ,y 171c Cr csvu Kd- Tl.T h R+ a+ u tt "I t�- i, 4 518 10 w d $e Ill fet -rake 2". (L ) ? cee t a I- rfid'irlb* aheo-, Will timber be cut and sold in parcel preparation? (Yes o) Is your property within 200' of the following: Body of Water (Name) 'Do+L•l Cr,,4 Saltwater Lake River/Creek Pond Wetland✓ Seasonal Runoff Stream. Slopes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Other Use of Building Describe Work ^ C.c- (--1 AA 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 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 MEANS 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-I 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 approval. X '7�u%� Date X Date FOR OFFICI L USE BEYOND THIS POINT Accepted by Date C f-Z.-Submittal Amount Due �. Receipt No. Li DEPARTMENTAL'REVIEWN APP OVER D COIVDIT1vN COPES Building De a nt� _ Occ Grou T e Constr.V t! IYIC ►' ✓��' r�iro Planning Depart ent /sec �.�. Environmental Health bepartment C P. \, Ll 1 orks Department Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES l FORM,MUST BE COMPLETED IN INK PERMIT NO.: PLEASE PRESS HARD MASON COUNTY 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 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner W k c: w. Gto& Contractor Name A,kt A se44• Mailing Address /.Sr 2?/,,4 NGi = r Mailing Address Cr 3cr £'. "-e R.i City L.ejt,' State c-} Zip Code 9z4 1 City 5h4/f-f-► State wf+ Zip Code` Phone Other Ph.( Jy' `11-2-7k 71 Ph.( '34 U )� 2,4 - •73�dOther Ph. ` (,c 2 -S17L�r_.;, Lien/Title Holder C.L..._i,:tj w;-4 - Ham. L< Contractor Reg. # A vS 6•T co-:. 3 4 c z Address N 3:,4 io 1-i'► \A�^ f4k : c;v `i 1 Expiration 3 /(e/ v SEPTIC INFORMATION-Connect to New Septic Existing Septic_k,-*' Connect to Sewer System Name of Sewer System PARCEL INFORMATION - 12 digit Tax Parcel No.32 2 3 3 / SC, Fire District V y Legal Description All+Aai— ;,f rt.._ Ea�;t ?4.41 1�-• r r1 W ?sY.J'z o f E„fi L«3 S« 3 3. Tc w ;1. e 2 Z &1. Site Address (Please include street name,street number and city) G :1 Y3 E, S"ll-a-fe- !4 41,wT, b A , w�} Directions to site rr-o.r a.lc, Rdl --? Me Cre&VI•`?d. •TiarN '1Zt e-t- bal l., 'Na '7R+ C:/,'1-v S-iR IL -f-G hoµrc s trn�yl.� akt d. Is your property within 200'of the following: Body of Water(Name) i�a/�,, Cfcc% Saltwater/ Lake River/Creek Pond Wetland Seasonal Runoff Stream,,-, Slopes or Bluffs TYPE OF JOB New Adder Alt Repair Other Use of Building "7v►x Q Lam' Trio 1 Location of Fixtures/Units 1st Floor:/ 2nd Floor Basement Garage,i Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater M OV t n U Propane Tank Clothes Washer ( Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Z. Dryer Vent Other J A"M I Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL 8.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 MEANS 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-1 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 approvval.,/ first obtaining approval. a,4-� Date f 2 5j_t y X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. ... ....__.__........_...._ DEPAiRTMENTAL:RE tEVif iRPFROVED . :.;:gENIED OOM1IDFtIS1N::Cfl:FT B Building Department Occ Group Type Constr. Planning Department Other Other FEES `,I Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES 2 1� f Q�� 47 �E%,L� � m T.ING N Li I > v 011 /A � lob