HomeMy WebLinkAboutBLD2001-00244 Deck - BLD Application - 3/19/2001 PERMIT NO.: BLD
Z6D 1.M2yY
MASON COUNTY
BUILDING PERMIT APPLICATION 3-t9
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 F: /`7`�°---' Mailing Address
City . State Zip Code City State Zip Code
Phone( '" Other Ph.( Ph.( Other Ph.(
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System Well if Wate
Water System -Y7�� r System Name of
77
PARCEL INFORMATION-12 digit Tax Parcel No. / / -s' Fire District
Legal Description 5's0
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 your property within 200' of the following: Body of Water(Name) 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
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 rcl man Model Model Year 7 % Rest
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-1 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 Date - I Q + X 4+ Date ' d
FOR OFFICIAL USE BEYOND THIS POINT- 9
to !r'
Accepted by Date Submittal Amount Due Receipt No.
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DEPARTMEAIT tVl; APPROVIwD UENtED<' �fy,IVDI T17NdE
Building Department 3119101
Occ Group -1 e Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
FEES
Building Permit Fee (n3 Site Inspection
Plan Review Fee g� EH Review Fee
Plumbing&Base Fee Planning Review Fee
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee State Fee L So
Violation Fee Pre-Paid at Submittal
TOTAL FEES
'k MASON COUNTY PROJECT SITE INFORMATION
,drNT
S/U��` Case No.
Name 4�roA PARCEL NUMBER 4,44 L,a ICO J?O CJ Date "/4
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 sjyoreline or within 100 feet of adjacent property line.
adjacent property line- 1 j I <—adjacent property line
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adjacent property line-) I tL c!c I E-adjacent property line
SAMPLE SITE PLAN
adjacent property lined 32_0' _ _ Fadjacent property line
v so raES�a�E 30,
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CREEK \ I' fi HOME i ,C'fZ&0_U1
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adjacent property line--.* Fadjacent ro ert�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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Signature D Ate
Case Activity Listing 3/15/2005
8:41:25AM
Case#: BLD2001-00244
P10
Assigned Done
Activity Description Date 1 Date 2 Date 3 Hold Disp To By Updated Updated By
BLDB110 Building Plan Review 3/21/2001 None HOLD JRN 4/11/2001 JRN
support inadequate,cannot bear on manfactured home foundation,left message w/owner JRN 04/11/2001
BLDA915 Existing Records-Case Manager None 3/21/2001 K L W
BLDA010 Application Received 3/19/2001 3/21/2001 None DONE KLW 3/21/2001 KLW
BLDB135 Addressing 3/21/2001 3/23/2001 None DONE GMM 3/23/2001 GMM
BLDB138 Planning Pre-Review 3/23/2001 3/27/2001 None DONE KLF KLF 3/27/2001 KLF
BLDB130 Planning Review 3/27/2001 4/4/2001 None DONE SLO SAL 4/4/2001 SAL
BLDC100 Inspection 3/15/2005 None DONE RLS 3/15/2005 RLS
Old single wide gone and no porch constructed the old house was replaced with bld2000-01451 1998 41'x 48'
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