HomeMy WebLinkAboutBLD2002-00147 Garage - BLD Application - 2/6/2001 PERMIT NO.: BLD C�✓l.� �1 I
MASON COUNTY ]
BUILDING PERMIT APPLICATION 2lCp
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( F1,4ZZ Other Ph.( Ph.(_ Other Ph.(
Lien/Title Holder f__L[S Contractor Reg. # I'LY'Git1
Address LIAn, Expiration / 06�_/JCL
/r '-S(
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name o��ewer System uVeIf— -AL J'o`arV System Name of
Water System
i
PARCEL INFORMATION-12 digit Tax Parcel No.�'a,Wi:� /lam _/ / G/ Fire District__
Legal Description "
Site Address(Please incfud4 street nanie, street number and city)
Directions to site ( S`
Will timber be cut and sold in parcel preparation? (Yes/No)
Is your property within 200' of the following: Body of Water ame) 4 Saltwater
Lake River/Creek Pond Wetland Season Stream Slopes or
Bluffs
PERMANENT RESIDENCE I] SEASONAL RESIDENCE❑
TYPE OF JOB New 4 Add Alt Repair Other Use of Buildin
Describe Work
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor
3rd Floor Loft Basement-X arpoDeck Other sq. ft.
ge Gara (:: Attached Detached Crt Attached Detached
MOBIL" INFORMATION-Make Model Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase Pi-4 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-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 conforman a therewith. No changes shall be made without
approval. first ob �ning a v .
X Date X 4" Date
FOR OFFICIAL USE BEYON6,.THIS P.
Accepted by ` Date�Submittal Amount^Due o ~ , Receipt No. � ,4
;`'s DEPARTMENTAI»' EVIEW APPROVED DENIED CONDITION CCIDES
Building Department ri , 6ro S
Occ Group Type Constr. yp 1 T 0 C. q L
Planning Department F`f r.,�r \Jr1
1~ IA
Environmental Health Department
Public Works Department
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Fire Marshal
Valuation $
FEES
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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
I
Violation Fee Pre-Paid at Submittal ( )
TOTAL FEES
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MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name !PARCEL NUMBERF22J�5- Date
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the
site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Well Location (including adjacent) Drainage Plan
Names of Streets Easements
Names of Fronting Streets Septic System
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property lined I I -adjacent property line
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adjacent property line- I E-adjacent property line
SAMPLE SITE PLAN
adjacent property line-> 3io- adjacent property line
I D 30" rRFSCRvE Soil
SEaso%J AL I L !
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adjacent property line4
� \; Fad'acent propert' line
TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the
degree of slopes. See sample topography profile.)
SAMPLE TOPOGRAPHY PROFILE
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2-11 )0,&
Signature Date
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