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Home My WebLink AboutCOM2004-00055 Wild Willy's Smokehouse Sign - BLD Application - 3/11/2004 MASON SO COUNTY BUILDING PERMIT Permit No�ZD��l�D� 'te Address 2 Owner / Contractor Reg. # Job Description ��/� ��jf�,, i S 6%,-A—Pu�_ Foundation Footing Foundation Wall Below Grade/Slab Insulation Plumbing Inspection Mechanical Inspection Frame Inspection Insulation Inspection Wall Board Inspection Fire Marshal Final (commercial only) Final Inspection VA Applicant Must Call Issued By 427-7262for Required Inspection POST THIS CARD IN A CONSPICUOUS PLACE AT THE FRONT OF PREMISES. This Building NOT To Be Occupied Until Finaled MASON COUNTY PERMIT NO. 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 APPLICAN INFORMATION CONTRACTOR INFORMATION Owner Company Name -�- Mailing Add es Mailing Address `-- City !�) ',.0�(4YCd�e—Stat _Zip Code G 'L, City State Zip Code Phone_,IV\ Other Ph. Phone Other Ph. Lien/Title Hol e 4P 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 Water System Name of Water System PARCEL INFORMATION - 12 Digit Parcel No. Fire District Legal Description Site Address (Please include street name, street L mber and city) Directions to site Will timber be cut and sold in parcel preparation?Yes/ No Is property within 200'of Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or 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 PRIMARY RESIDENCE ❑ SEASONAL ❑ Use of Building athroDescribe Work No.of Bedrooms No. of oms Squa ootage - 1st 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 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 permis- sion from all the neces ary parties.If permission is required from any easement holder or any other party in interest regarding this applica- tion e work ro e,0 in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. Ix .� Date: 3 A/°,/ Owner owners Representative/Contractor (indicate which one) FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Planning Pd k# Date Bld Pd Receipt No. DEPARTMENTAL REVIEW ED ENIED NOTES Building Department Planning Department Environmental Health Department Public Works Department Fire Marshal FEES Buildinq 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 Violation Fee Pre-Paid at Submittal Valuation $ TOTAL FEES