HomeMy WebLinkAboutBLD2011-00586 Cancelled ATF 24x48 Shop - BLD Application - 7/6/2011 MASON COUNTY PERMIT NOILD DI I mot✓( J �/
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
On the web www.co.mason.wa.us
APPLICANT INFORMATION CONTRACTOR INFORMATIO!!5f
Owner 70 llA �- F—,_ Ae_bQ11 Company Name
Mail' Address `- Mailing Address
City C a � & w F1Zp Code City State Zip Code
Phone Z St Other h. Phone Other Ph.
Lien/Title Holder U Contractor Reg.# Exp.
E mail address e _ E Mail Address
Drivers Lic.# �t� DOB I Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic X
Connect to Water System Name of Water System
Well--6—Water System Name of Water System
PARCEL INFORMATION- 12 Digit Parcel No Fire District
Legal Description
Site Address(Please include street name, street number and city)
Directions to site
Will timber be cut and sold in parcel preparation?Yes/No
Is property within 200'of Saltwater YtAD Lake V _River/Creek _Pond VI
Wetland ) .p_Seasonal Runoff )2 L Stream Y\Q Slopes or Bluffs ] 15% VA
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 PRIIy�A3Y�ESIDENCE SEASONAL E]Use of Building �hM Describe Work �-k-7
No. of Bedrooms No.of Bathrooms Square Footage- 1 st 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 E[nC rl t 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 infomtation
provided is accurate and grants employ of ason County access to the above described property and structure for review and inspection.
PROOF OF CONTINUATION OF W 'FANS OF PROGRESS IN
DateECTION.
Owner/Owners_Represe�ttive Uontractor (indicate which one) 7 b
FOR OFFICIAL USE BEYOND THIS POINT Accepted b : -� Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
Building Department It &4,
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbinq&Base Fee Planning Review Fee
Mechanical& Base fee Other
Wood/Gas/Pellet Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation$ TOTAL FEES