HomeMy WebLinkAboutBLD2008-00903 ATF Guesthouse - BLD Application - 7/18/2008 MASON COUNTY PERMIT NO. I -�c
BUILDING PERMIT APPLICATION �0
426 W. Cedar- RD. Box 1-86, Shelton, WA 98584
Shelton (360) 427-9670 - Belfair (360) 275-4467 - Elma (360) 482-5269
On the web wvi mco.mason.wa.us
APPLICANT INFOR AT CONTRACTOR INF RMATION
Owner Company Name
Mailing Ad res Mailing Address
Cit Stat Zip Cod City State Zip Code
Phon&4' i ~s2?%=4Q 6ther Ph
Phone d Other Ph.
Lien/Title Holder Contractor Reg. # Exp.
E mail address E Mail.Address
Drivers Lic.# DOB Drivers Lic. # DOB
SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic
Connect to Water System Name of Water System_
Well Sewer System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel Fire District
Legal Description _
Site Address (Pleas in lude street nam ,str et number a d city)
Dire tions to site
t
Will timber be cut and sold in parcel preparation? e /No
Is property within 200' of Saltwater Lake River/Cr e Pond
Wetland Seasonal Runoff Stream Slopes ot'Bluffs -15%
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 RIMARY RESIDE ❑ SEASONAL ❑
Use of Building Describe Work-
No. of Bedrooms No. of Bathrooms re Footag 1st Floor 2nd Floor
3rd Floor Basement Deck— ,pq
e-overed Deck Other Sq. ft.
Garage Attached Detached A, , Carport Attached Detached
MANUFACTURED HOME INFORMATION - Make Model Year
Length Width erial No. No. of Bedrobi�s No. of Bathrooms
Type of Heat urchase Price $ Replacemenf'Unit? Yes/ No
Installer Name Certification No.
OWNER/BUILDER Acknowledges submission of' accurate information may result in a stop work order or permit revocation.
Acknowledgement of such is by signature below. I eclare that I am the owner,owners legal representative, or the contractor. I further declare
ro osed in the application. I declare that I have obtained the permission from all
i receive this permit and to do thfe work as p pp
that I am entitled to p P
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 informaticn provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application 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 OF WORK IS BY
MEA A P GREWINSTIOI�&CTIIVITY OF THIS PERMIT APPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X , Date:
Owner/Owners Representative/Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL REVIEW APPROVED DENIED NOTES
BuildingDepartment f� t
Planning Department
Environmental Health Department'
Fire Marshal
FEES
Building Permit Fee Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee PlanningReview Fee
Mechanical & Base fee Other 3:
Wood /Gas/ Pellet Stove Fee State Fee
Violation Fee `=: Pre-Paid at Submittal
Valuation $ TOTAL FEES