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HomeMy WebLinkAboutBLD2017-00877 Repair Fire Damage - BLD Application - 9/23/2017 /, • MASON COtiIVTY C4MMtlNITY SERVICES Permit 1\0:old ab11�C1 l PERMIT ASSISTANCE CENTER: .fRXDftVG•P'LAWNG•PSG HEALTH.FIRE A44RSHAL 615 w-Alder Strsat Stmh—.WA 98584 c2 Phone Shedert-(36M427-9670 erf 352.Far,(360)627-779S Phone &elfar(360275-4W•Phom F1ma.(360482-5269 _ BUILDING PERMIT APPLICATION PROPERTY OWNER LNFORMATION: CONTRACTOR INFORMATION: NAME. k" _ MAiLI 'G ADDRESS:jl,l C 41l �St . MAILING ADDRESS: iQ�I a pA P3 t ✓ , i CRY:. STATE 7.iP: CITY:1A�Q� S!A'ITi: liP:_ C)3 PHONE1ri5 _ 3j� PHONE: T CEL PIJONI P2: EMAIL. _ it FMA1L ' '��Y�V\Q _r L&i Rki# �k. y—&s a��`t PRIAi Y CONTA OWNFR fj— CONTRJ4CT0R OTHER L � NAME EMAIL�I�N')I LSLAIM� .4t7vL MAILING ADDRESS CITY STATE ZIP_ PHONE CELL PA CEL INFORMATION: _ PARC..t.2t k UBER(12 Neit Number)- — LLGnI_{1FscRIPTION{At$trcviatai); r�kr 1atr.nl t1 to A __ FIRE DLSTRICT�_. — SITF AIIDRRF.SS CITY DIRECTIONS TOSITE ADDRFSS --.._�— i tS TtiE MOJEtT wTTNIR 300 ET O St.OPI;(S)GREATER TII.AN 14%-. Y'IS[ N,()_j IS PROPERTY W1111W 200 FT OF THE FOLLOWING: rr7rsl s!f dun urfho + SAU17WAIYR❑ LAKE-© RIVE-R&REIK❑ POND[; WLT1,ANDJ SL•ASCNAI RUNOFF0 STREAM j s TYPE OF WORK: NEW L- ADDITION D AL'fF.RA'ROty o REPAIR OTHER n USE of:STRUC IAJRE( IS USE- PRIMARY LtA SEn.T(RiAL Q NUMBER OF tat tJRfXTMS Afl1MDTR OF IiATI1R(X)SdS } 11(.ATF-A)STRIRTM NIT D ICRIBE WORK 6'i iI�- �r rzta u2 h'�thG SQUARE FOOTAGE: tST FLt)OR sq R. 2tiD FI.(X)R sq.A. 3RD FLOOR sq.IL BA.Sr:MF X7 sy tl 1)11'k sq ft. COVERED Df xi fi S'Ir*AGF W,A CT 14ER _sq ti GARAGF N.i}. AtiacAad inched[t' CARPORT sq is Am he [] Lkrm.J+rd[J 17AN FACTO"HOME INFORMATION= —*4 COPIES OF THE FI:(X)R PLAN RI':QUIRED* MAiCI_�'_I�'✓ _-_MODEL YEAR tXW;TH WiDT14 __ __ B�EDROOACS_ BATHS^___-SERIAL NUMRF,R_ ENVIRONMENTAL HEALTH: SEWAGGSE-WERS(WRCE- Sr:PTiC g SM- T-R[s NI:W EXr.%nNG s PLUk191\GIN STRUC'TURF9 YES 2, NO❑ lfve&anwhaorrgdrted WwwAdequan•Tarm } PERIMETER/FOUNDATION DILMM PROPOSED° YES NO;_ EXISTING SQ.FT. L XISTIN(i BEDROOMS_1 PROPOSED BEDROOMS TnT.4L BEL)RO()M5 _7 i --- — ---- —__.i owNER a knoswsooes rge suonssion d afawum xwontotiDn may mma in a stop wort order w DWM revocation_AWVAelomem Of wch is by signature bebur-f d..La OW t—rte n..•.e*and i f.,ttw declare them f am-egged to recasve ftvs p rsdt mt to do 4.e wom es propose-t trove j obtained pe�rtniadicn Stain aft the rnoe--y parties.vtdudit any,aaseff..0 hofda m pantos of mtd e,t regarding tt s project The otiwNer or 7epat i teprese wye.represents thai the mt malion Provided is axlsat and Tvils.unplt:yees of Mason County axm to fhe&'me desu*ed p.'o" 1 and sfixfinefs}for review and inswfio a. This pennWamicabon becomrw mA&vnid ifwork orautlt Mod conshuctM n not corm w,0fA totem iW } days or>f constucbon work w suspended for a penod of 1B0 days. PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS PERMIT APPLICATION OF 18o DAYS OF MORE WILL CAUSE THE APPLICATTi1N TO BE EXPIRED.(mAsont COU*n Y CODE U 09.42)` ���7 Lxl � Skpature of OWNER Est be signed OWN Dale OWNER �Da;e DEY%AT!►IE.NTA.LREVIE,11 .&PPROVED DATE DENIED DATE 'YA4'ti7?kOTF1tifCU\Uft`IQtis BUILDING MPAtrIVE:N PLANNING DEPARTM1�vT FIRE MARSHAL - PURUC HEALTH MASON COUNTY COMMUNITY SERVICES permit No ♦ PERMIT ASSISTANCE CENTER: •BUILDING •PLANNING •FIRE MARSHAL 615 W.Alder St-Shelton, WA 98584 www.co.mason.wa.us Phone Shelton:(360)427-9670 ext. 352• Fax:(360)427-7798 Phone Belfair:(360)275-4467• Phone Elma: (360)482-5269 PLUMBING & MECHANICAL PERMIT APPLICATION OWNER INFORMATION: CONTRACTOR INFORMATION: NAME: Tim &)eyl Wla v\yl _ NAME: (\k cS,-,A e_l V6a — MAILING ADDRESS: MAILING ADDRESS: \SZao Rxuuxx_)cA St S F_ CITY: RA W A STATE: LOA ZIP:q CITY: STATE: LLA ZIP:QtS�p3 1st PHONE: Ot k l clS4 CELL: 3b 0"(4S 4cM 2°d PHONE: EMAIL : I l 1 (oex� EMAIL: A, tiev� P 4&t V 'Corn L&I REG# 1 k- 14L50&N33C EXP.Q- 31 / iq PARCEL INFORMATION: PARCEL NUMBER(12 Digit Number): �0`1��(� -5S-0074._q Zoning: LEGAL DESCRIPTION(Abbreviated): �D�ClL�,v,CI V���1stC�p tot a SITE ADDRESS: \\10 \ 'e- - VD'Lv\'&v^ 9r^. CITY: 1 l� DIRECTIONS TO SITE ADDRESS: - C\0 1�—'x \-A- VV't-3 tJ ult N F�bm sfi ,0— V , L'A t rz tr dLV, Zk s--. &w, V.rw fir, TYPE OF JOB: NEW ADD ALT REPAIR OTHER USE OF BUILDING LOCATION OF FIXTURES/UNITS—I sT FLOOR +/2ND FLOOR 1/g—ASEMENT GARAGE bTHER PLUMBING FIXTURES(SHOW NUMBER OF EACH) MECHANICAL UNITS Type of Fixture No.of Fixtures Fees Fuel Type:Electric ✓LPG Natural Gas Ductless_ Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs _ Heat Pump Showers _ Spot Vet Fan 7_ Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks ( Wood/Gas/Pellet Stove Dishwasher r Kitchen Exhaust Hood i Hose bibs Dryer Vent Other Solar Panel Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL OWNER acknowledge 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 contractor. I further declare that I am entitled to receive this permit and to do the work as proposed. I have obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project.The owner or authorized agent represents that the information provided is accurate and grants employees of Mason County access to the above described property and structure(s)for review and inspection.This permitlapplication becomes null&void if work or authorized construction is not commenced within 180 days or if construction work is suspended for a period of 180 days. PROOF OF CONTINUATION OFTHIS PERMIT IS BY MEANS OF INSPECTION.INACTIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION. X Signature of Owner Date DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS BUILDING DEPARTMENT J72_ cl-t2-f7 PLANNING DEPARTMENT FIRE MARSHAL Visit us on-line: http://www.co.mason.wa.us/community_dev/ Rev:1/27/2016 JBN