HomeMy WebLinkAboutBLD97-0551 Cancelled Convert Garage - BLD Permit / Conditions - 1/21/2000 MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
!_I 1 I_ C) I N Cs P F. R IA 11 1 FOR 1 I 1 (.jNb ( /tt L 4//- 1,46 1 1
BETWEEN Spa► AND ears 41;,17--7262
BLD97-0551 PARCEL. : 123305100079 PL.ATtBFPIO DIV : BLK ;
JOB ADDRESS : 11 NE SKIPPER CT BCLFA 111
OWNER : SHELL L U?I G PERMIT
CONTRACTOR : NULL & VOID BY EXPIRATION
LEGAL ;: BEARDS COVE 14 RIK 1.01 78 OF 11 SKIPP€N COUNT
1 2-1.(1 BY Wit)
CLASS OF WORK . . :OTH SEDR : 0 BATH : 0 I'3`PE ANOUNI 8Y DATE RECEIPT ITYPf ANOUIII BY DATE Attl IP'(
1 YPF OF USE . . . . :SF STORIES — _ — : 1
OCCUP . GRO1.1P . . . :.R 3111 lit DG . HE I GHT . . : O .0 t t F110 ! 26.00 KS 09 24197 45521 �
TYPF OF C:ONST . : ,.SN C I REPL.AGFS . . 0 111flo ! 11.00 KS 09124197 45527
OCC►.IP . LOAD , . . . . O WOODSTOVF•S . _ . . . 0 PONT ! 70.7F KS 09124147 4552
DWE!_1_ .UNITS . . . . 1 PARKING SPACES : 0PICK ! 28.30 K, 09124107 45527
thISPEC'l ION AREA ; 0 SIiORFI INE7 . . .. . :N 'STfE ! 4.50 KS 09124197 4551 TOTAL: 200,55 VAINLATIONa 648t�
� SF=TBACY, —_.._._____._ _._.__ TOILETS . . . . . . . , . . : 0 FUEL TYPES---------._..• BOIL.ERSiCOMP --- 1010611_E H<TME-- -
FRONT .. . .F 10 .Oft BATH BASINS . . . . . . , 0 : /FLE/ / / 0--3 tip . ; �
REAP . . . .W 10 »Oft BATH TUBS . . . . . . . . a 0 3-15 HP . : 0 I40DEL
SIDE ( 1 ) <N 10 .Oft SHOWERS . , . ' ' ' ' : 0 1 ORN < 1 OOK BTU : 0 15 30 HP : C/i {yA}rF
S I DE (93 ) .8 15 .Oft WA.TFR HEATERS . 0 FURN >-1 00K B 1"V : 0 30-50 HP 0
SHRL INE . O .Oft Ct OT TES WASHERS . . : 0 FURN FIOOR _ t 0 .04 tip . : O AREA _ ._._._... ____...__.___ rrrcHEN SINKS . . . . : 0 HEAT PUfAP . . . . . . : 0
LOT SIAF . , : FLOOR DRAINS . . . . . . 0 VFNT SYS1kMS . . . . 0 FVAP COOLERS : 0 1FNGIH ., 0
RUIL.DING . . , a Oaf DRINKING FUUNT . . . : 0 VENT FANS . , 0 HOODS . . . . . . . . 0 WIDTH . . 0
BrASEIAENT . . . : 0 ti f I AUNF A Y 'T PAYS 0 Dt mps I NC I N -x O *F E i A1.. 4
P CKS • . . . . Osf DISHWASHERS 0 AIR HANDLING UN I T`S- -- Cr 04ML. I NC I N :O
GAR/CARP :G 480sf GARR DISPOSALS . 0 10000 ufm . . 0 RFLOC:/RF-PAIF . 0
ATi a'f . ,A URINALS . . . . . . . . . . 1 0 > 10000 c hqt : 0 OTHER UN I TS . : 0
041 SC': Pl M F 1 X"T(JkF S . 0 GAS 011T1. FTS . : 0
-scarmier-..a:zss+:�xcr:l=;a.-c.,� .sasrsc�.;�r-z:..rr�rzmzxxrara.�.s:a:,scr.:i-a:a-�c�sc»..zz~c:�sas.�r..:.�;rstss.�camau.s�:c-:cre<a:.ar.-�:.¢...=awF.r^aa.•c.-,...:a....•a.. s::;.a��:rsa:.as.:a+�exRm�;s:f:.r-mm:xa..r::,.;arsv..ae�.:��:mR�xmxa.arrzr.�.-c-^u:.-mc.y.
PAOditT DESCNiPT1UNr8UI10 NFW @TIACNfD GA1AGf184EfTROt1 AND PAINT OID EXISTING 4ARA6F AND CONVFIT TO FAVIII ROOM,
PROJECT 1OCATION{RIGNT (10 SAND1411.1 : lfrl nN IARSON RIND, 1EFT 00 SKIPPER CT, FIRST 4011Sf ON IffT.
INIS PFRNII QFCONES N0L1 AND VOID IF NOIlt 00 CONSTRUCTION AIITNORIZER IS NOT CONNENCED NITNIN I 0 DAYS, OR IF C0NG1111016N OR RORK IS SDSPf.N0EI1 FOR A PfR130
Of Is# DAYS AT ANY TIME AFTER WORK IS CONNf"NCED. EV1Dfl{CE (+F CONTINUAT1OP ff $OAK. IS A PROGRESS IN"PECTiOkV IININ THE 180 DAY PERIOD. FINA; INSPtCTION MIST Ff
APP9OVE4 OFFORE BUIIIIING CAP SE Oc3pl fO.
ONNfR OR AGENT OTC, l= r. :_.. ._._. __._... . . _.: ,._.._ ..__.__... _:_ .__..._ OAIt
81.0_NETT, rev: 03131111 COMPLIANCE TO A FTACHED CONDITIONS IS REQUIRED
——————————————————————————————-
MASON COUNTY
Mason County Bldg. 111 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
C6se No , i BLD97-0651
For r SHEL I LIJZ I C,
Page : I
I hey undersigned pr,,vpertV own"r It-, dware o.1 the an(;,Vrtairkzy regardtriq the on Countv ' ,i
development reglilations created by the Growth Managment. Hearings Board 's Order -:If
October 2 , 1996, and in consideration of �,Wson County 'r, willingness to proceed Afith
processinq of applications which might be affected by the Order , the undersigned
roperty owner horeby agrons to Waive, ar)v lawsuit , aot ion, or, claim for damages n(jalrist
Manson County which ma,/ arise out of Mat;on County 's actions In acceptance, processing
and/cr ist;uanue of stjoh permits or approvals-, ( hereinafter "perm ittinq cant ions" ) , whl (r-h
damage are attributable to the County 's decision to take permitting actions de sp I t
the risk that chsinges to the County 's development reqtilatlor)� morltit later- make t?)e
ounty,'s permitting actions Invalid ,
The use, handling and storioe of hazardous materials or flammablo and comt List ible
liquids in excess of 10 qallcans Is not allowed without the approval of the Mason Cc-)unty
Fire Marsha l ,
1 -1
X
ut I I i ty Arid drq i natle easewiente; of 10 '
Structure atij fit be ne t har.k 5 r om a I I I
from each roperty line. or a variance must be obtained from the RuIld'Tingt'lielpartment .
X
4 ) Proposnd structure or any portion thereof greater than 30" In he, ight fr-orl) grade I I ne.
must maintain a minimum of 5 ' ;etbar,,k from all property Iine6 , easements and 10 from
aX ll Cotinty and State Road right of waVs .
5 ) A I I' approved p I ans are requ I red to be (.)n- s 1 t*- f`o r I n,-,p e c t I ,,)n purposes . if lrt,.-peotion
Is called tot, and plans are not on site, Approval WILL NOT he ranted . In addition , a
Re- Inspection fee in the amount of $32 .00 per hour tin inimum I Rour ) will be charood and
must be collected by this department prior to any further Inspections being performed or
appr ova I ranted .
X
i F
MASON COUNTY
Mason County Bldg. III 426 W. Cedar
P.O. Box 186 Shelton, Washington 98584
fii
AND LEGIBLE Ff.'OM THU SfALET OR ROAD FRONTING TtjE PROPEFIfY MASON 601';NiY BU11.01NG
DEPARTMENT REQUIRES THAT THIS BE COMPLETED PRIOR TO CALLING FOCI ANY SITE INSPECTIONS . A
RE I NSPECT I ON FEE BASED ON PATES IN TABLE 3A OF THE 1994 UN I F(7i`M RU I LD I NG CODE WILL BF
ASSESSED IF OWNED/CONTRACTOR FAILS TO POST ADDRESS ON SITE PRIOR TO REQUESTING
INSPI CTIONa .
T} ALL. CONPT,, UCT I CAN MUST M ET OR FXVf-FD ALL LOCAL CODES AND tIBC PrOU I REME NTS .
x_
8 > Changes to approved building plans th€�t Ptfc :�t compl ianc+e t€� the 1991 Washing on ",tote
Energy Code, 1991 Ventilation and Indoor Air Qua I I ty �
Corte , the Unitorm Sul Idiny Dade and/or Mason County e�ss +^�ik�Icns must
be approved by Masan County prier to oonstrmot ion
9 ? CONSTRUCTION PROCESS To BE FIELD CORRECTED AS 01 RED PER MASON Caf3ONI Y BU I i D I N
DEPARTMENT AND IIN I FORM BUILDING CODE .x_..._.
y
r
CONCRETE T. MECHANICAL MOBILE HOME
Footings-Setback GQ�L`y
9 ' date by Ribbons
date ` by - i Gas Piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
Permit No.
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 AL
(Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
PLEASE PRINT
#1 ner Lc« i< Phone#
rf"Cy
Address 1�f(- I i(Z>�e.� C y Fire District#
r St LA->; Zips S�
Directions to Job Site (� ,b..� 5'a�•� ( ( , l r V" LCU-T-&-- &".X4 (off
Stl Rper
Owner Mailing Address '—
City St Zip
Lien/Title Holder
Address
City — St Zip
�L�
#2 t Contractor Name Cr�-L 5 !!'r:kon r4-\L. Contractor Reg#0-�6gL
Address ^ �� ;!96 Expiration Date Z
City- �'-s>e St Zip g6 S3 Phone# 731
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
# rNcel No1�3�3b - S - n
Legal Description )b'iJ t-Q — lc� �G B,ti�S
4 -
#5 Building Square Footage:
c1 gBedrooms
t FI �� 2nd FI 3� 3rd A Loft Basement
'3 #bathrooms :D Deck cSV' Other
P,, Garaged b Carport (Circl :'Attache or Detached?)
#6 Use of building Describe work
#7 Type of Job: New Add _Alt Repair Other a 1
#8 MOBILE/MANUFACTU ED HOME INFORMATION .0
Model Year NBa
Model
Length WidthSerial No.
# Bedrooms ooms Type of Heat
Purchase Price$
#9 Indicate by circling the applic ble source if any water is on or adjacent to subject property's
River Pond Creek Stream Vetland Lake Marsh Saltwater Seasonal Runoff Other
Show following on the site plan
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Drainage Plan Wells
Septic Systems Easements
Proposed Improvements
Name of Side Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLICANT TO DRAW SITE PLAN BELOW
NI
E,a 2
� I
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No._Toilets CIRCLE FUEL TYPE: Ga4lectric
Bath Basins Heatpump, Other
Bath Tubs No. Units Fees
Showers Furn BTU
Hot Water Htr _ Heatpumps
_Laundry Washer _ Vent Systems
Sinks _ Spot Vent Fans
Floor Drains No. Boilers/Compressors
__Laundry Basins _ HP
Dishwasher No. Air Handling Units
Disposal _ cfm#
Urinals No. Fire Protection Systems
Other _ Auto. Fire Alarm Sys 50.00
Fixed Fire Supp. Sys 50.00
Permit Basic Fee 16.75 _ Auto Fire Sprink Sys 35.00
TOTAL PLUMBING $ No. Other
Gas Outlets
Wood, Gas, Pellet Stove
NOTICE: THIS PERMIT BECOMES NULL AND VOID IF
WORK OR CONSTRUCTION AUTHORIZED IS NOT COM-
MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 16.75
WORK IS SUSPENDED OR ABANDONED FOR A PERIOD
OF 180 DAYS AT ANY TIME AFTER WORK IS COM-
MENCED. PROOF OF CONTINUATION OF WORK IS BY
MEANS OF A PROGRESS INSPECTION.
OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT
I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED
MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I
RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU-
ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED
MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE
CONFORMANCE THEREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT
MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDING DEPARTMENT. DEPARTMENT.
X OWNER X BY
DATE DATE4'1�
FOR OFFICIAL USE ONLY: Accepted by: Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
1 Approval
Planning: 'l-l(y��4
Environmental Health: �v
S-LI-`1
Building Plan Review 7-7-9-7
Occupancy Group: 3 / Type of Const: 5
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit -75
Plan Check 8 3°
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Violation Fee
Site Inspection
5 Building State Fee Sv
Other t
Other
=Buildingation: TOTAL FEE s5
S7A GARY YANDO,DIRECTOI
yON. TF�
M U DEPARTMENT OF COMMUNITY DEVELOPMENT
S T Z PLANNING -SOLID WASTE- UTILITIES
N Y y BLDG. I * 411 N. 5TM ST. • P.O. BOX 578
of �� SHELTON,WA 98584 o (360) 427-9670
1864
DISCLAIMER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's
willingness to proceed with processing of applications which might be affected by that Order, the undersigned property
owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of
Mason County's actions in acceptance, processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'),which damages are attributable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
Date (Parcel No. or Legal Description)
�-�Ler's
S —C� S
Property signature(Notarized)
(or the County may accept the signature of the owner's authorized agent upon proper proof of authorization)
ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL)
STATE OF
COUNTY OF
On this _day of , in the year ,before me Notary Public,
personally appeared personally known to me to be the person whose name is
subscribed to this instrument, and acknowledged that he/she executed it.
WITNESS my hand and official seal. -For County use only-
Reviewed by applicant on
(Date)
Notary's signature Staff Initial:
My Commission Expires:
APPR. NO. �•= CHG. REASON L,' L(i-T 101 t'; r, y c pA.1 C PAGE OF
SIZE v MOBILE HOME 14ARL E A, .UE•'I• 'I'aa.
MAKE F I E L 0 SHEET If 731 '= _
CHANGE
tti a YE r. s -. s r. ur.'r+.
MODEL E;GHR-01R H' "Dd•
SERIAL NO.
USE CODE I i= BEAR-L-1 COVE T
i 9 Y
1
PARCEL NO. _3-3- E, L 00,0r 1=.
ASSOC. RIP PARCEL NO.
BUILDING TYPE HCHUSE CONTACT 'i CONDITION BUILDING LIFE
DATE BUILT %` `%� RENTER CONSTRUCTION n- STYLE•='
BLDG. USE CODE i= REMODEL DATE EFFECTIVE AGE MARKET MODIFIER -_•-
CHARACTERISTICS PLUMBING FLOORING BUILT-INS
QUALITY F;1 Z T SINK _ FLOOR CONST. .iF,.}H—Ir- ALLOWANCE INTERCOM
EXTERIOR = W.H. _ FLOOR COVER ALLOW E= RANGE OVENVACUUM
ROOF COVER COMP LAV. _ TYPE % DISHWASHER i MICROWAVE
FOUNDATION C--ONCR TOILET .'} TYPE % GARB.DISP. HOT TUB
SHOWER HEAT TRASH COMP. SAUNA
BEDROOMS 1 TUB SHOWER HEAT-COOL FLEE REF.
BATHS C OTHER i FIREPLACE(S) HOOD d FAN !
TOTAL 4 ; —
BLDG. SIZE BASEMENT GARAGES CARPORTS PORCHES
1st FLR. ; Sb4 BSMT.OUAL GAR.QUAL FA ill? C.P.QUAL. PRCH.OUAL. rA.8-,1
v:FLR_ BSMT.TOT. ROOFING i«Oi'ih'' ROOF CVR. CONIC. :
2nd FLR. 3..6 A FINISH 'I EXTERIOR '�T v'i''•f i C.P. 'I DECK :T v
3rd FLR FIN.QUAL GAR.TOT. ( 4"Ca DIRT FL. BALL_
SPLIT LEV. MISCELLANEOUS GAR.TYPE ATTlrtH DEPR ' ROOF
ATTIC j ASPH. DEPR ��• Li�l1f• 1C„' �•�G
SITE VALUE v u u v ROOF TYPE
CON C. 84 ie i WELL ENCL
SKIRT MH 15 e I-', •c SEPTIC 'e�>v u' DEPR.
ASSESSED VALUATION RECORD REP.COST i 3 y, _' MH/OTHER BLDG.
.Yr. CURR.USE MKT. LAND IMPROVEMENT TOTAL ?��,DEPR. ; ,`6 LUMPSUM
'*mI LO Gu�E.,�e %COMP. LAND VAL.
1r1 01C' �u`�S4v 2vv G 4u ADJ.BLDG.VAL. iiC2, 41 4 ivt''.•1 1_�..'
1 a.. TOTAL AV. ,
'?L 15000 i 7Ci r?'•. C:u �u OTHER IMP. =s, iSA..i F, N.C.
u v s _ ^e Lr -.
�} iC0vcr, i 3£ TOT.BLDG.VAL. .ii> ir 505 TOT.MNO.S.
METHOD CLASS WATERFRONT VIEW I RD.1 TOPOGRAPHY AMEN.
O LAND N
Z w w o USE QUANTITY RATE VALUE =1 J Z Q Q<rn J J J
0 F w w¢o a U m m m x o w i~ a w a a? J ¢U
[rwLL Q2<cr CODE z o3dxo.g wai ¢¢Oaia¢ O J
a EO a 0 o OU m M x m�0 f 0 a C7 U 3 J O¢ 3 0U US o 2
2 3 a 1 2 3 a 1 1 1 2 3 1 1 1 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1
- a
MfV OPEN SPACE QUANTITY METHOD RATE VALUE$
�
MASON COUNTY LAND AND IMPROVEMENT SHEET
—ISALE IMP
44
19 SALE _IMP
SALE—IMP
UPLAND WATERFRONT
TOPOG: ACCESS LEVEL SLOPE COVER
BEACH DRAIN--- WATER SEWER
19
19
19
`
�* �� m ^��
-~^_-
~~~______-w—r wF______-"_____7_---_____- wF .(IT
________- -_-_____=_____r x_--___r________
_______(d!_r u_____T_ uT_________
� WrA___(&_r wrA___u_T_ wrA___v�__�_��
�
� /Mp___"a— T_��' IMP___.^—r___� /Mp "��
� ,&______T � � ______�^_____T__����__-
uw/ �__-___ um/ u T uw/ � T
� -______- . ___-_-_ --___- _-___-____ ____-_- _--__
^-_-__-r_-__'_ � ______r_________
"._____T________-
7on-____-_k�-____- Tan—° ren______��______�
TorAL ' /u/^L �� TOTAL
19___- 19____ 1e—
vvr_______,,a-_--_-r vvF "_____T_ vvp� �_—r_________
_____-_ T ___----_"___---r ,___--_J________�
T —
n___-_-T_ .______T________�
� w��— T wpA___"—r_— wpAor____
�
p/w � r /w� " r /wp uT
� ______- ____-
a___-_-T-__----__-- _____-^__-__-r-__-____- o______r__________
— ,a.—r ow/ ___^—r ____ um/ ___" T_��
________u______r "____--r «_____r_________
°_--___J "_--__-r �______T
____ _____ ___.
___,a—r ron___"—r ren___"_T____
TOTAL ,or^L rorAL --________
IMPROVEMENT SHEET
BUILDING CONSTRUCTION_ STC_ 1 ^ 'h B 19
Cabin Frame No. ms 19
Dwelling ouble Living _ J 19
Apartment _ Conc. Bik. Dining fl 19
Commercial Kitchen 19
Farm PLUMB BASE I Year Built tcl">L.. Year Remod. t
;Sink Z Lay. Bed Cost Condition
FOUNDATION D_ W. ! 2 Toilet : Bath / CLASS 1 11/2 2 ,)
C�oncr tp — G.D. Shwr. r=.,,<._�,_. i SQUARE FT., __�.�__
Post & Blk_ W.H. _ Tub-Shr. INTERIOR WALLS
/ A.W. Dry Wall Rate Adjustment
EXTERIOR WALL HEATING/COOLING Panel Base Rate
mar Siding_ Plaster Heat
_ Shingles Fireplace
Shakes FIr./Wi. FLOORS Ad'. Base Rate
Conc. Blk. Frcd. Air _ Soft ADDED FEATURES — + Extend
Vert. Ply. H.W. B.B. _ Hard Basement/Rooms
Brick Ven. Elec. B.B. l , Carpet Heating
Ht. Pump Concrete Plumbing
ROOF 1EXTRAS Fireplace
_ Flat Oven-Range BASEMENT ara e
Hip Exhaust Fan None lConc. Fir.
/i Gable Part Dirt Fir. Attic
- -- -
!Shed Full Garage Deck /J
Ims Porches 72- �M
Carport
r , tc
TOTAL
I ADJUSTMENT
6 Area X Rate
- - —i Added Features
.! Replacement Cost
24 v � Cur'nt X Local
— % CPLT/Dep/Obs
!
Depreciated Value
Additional Bldgs.
TOTAL ASSESSED VALUE
ADDITIONAL BUILDINGS Full
Value
TOTAL
d,
r
Revised 7-77
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MASON COUNTY COMMUNITY SERVICES
PERMIT ASSISTANCE CENTER: Permit No:
•BUILDING•PLANNING•PUBLIC HEALTH•FIRE MARSHAL
615 W.Alder Street,Shelton,WA 98584
— = Phone Shelton:(360)427-9670 ext.352•Fax:(360)427-7798 Phone
Belfair.•(360)275-4467•Phone Elma:(360)482-5269
BUILDING PERMIT APPLICATION
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
• NAME: NAME:
MAILING ADDRESS: MAILING ADDRESS:
CITY: STATE: ZIP: CITY: TE: ZIP:
' PHONE#1: PHONE: EL
PHONE#2: EMAIL :
EMAIL: L&I REG# EXP.
PRIMARY CONTACT: OWNER& CONTRACTOR❑ OTHER❑
NAME mld � JP_he l,eu uc EMAIL ,4ecr y� /�O '7 p itoo C��
MAILING ADDRESS I I1 Awl 7 e t CITY 1)L STATE ZIP 5,2
PHONE -/7 9 Y CELL S �
PARCEL INFORMATION:
PARCEL NUMBER(12 Digit Number) �L,�,3(�- "'� ZONING -S
LEGAL DESCRIPTION(Abbreviated) FIRE DISTRIOT
SITE ADDRESS I I nE 4�1� 'No P_}' CITYZej f ALJL
DIRECTIONS TO SITE ADDRESS
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREAT R THAN 14%: YES[] NO ❑
IS PROPERTY WITHIN 200 FT OF THE FOLLOWIN
SALTWATER❑ LAKE ❑ RIVER/CREEK ❑ PO WET ND ❑ SEASONAL RUNOFF❑ STREAM❑
TYPE OF WORK: NEW ❑ ADDITI N ALT TIO REPAIR❑ OTHER ❑
USE OF STRUCTURE(Residence,Garage,Commercial B[ Etc)
IS USE: PRIMARY ❑ SEASONAL ❑ NUM R OF BEDROOMS NUMBER OF BATHROOMS
HEATED STRUCTURE? YES (Whole Bldg) ❑ YES(Parr of Bldg) ❑ O ❑
DESCRIBE WORI {� _
S rOOR
F (propose+ -
1 ST 0 ft. 2ND FLOOR sq. ft. 3RD O R sq. BASEMENT sq. ft.
DECq. COVERED DECK sq.ft. STORA ft. OTH ft.
GARAGE sq.ft. Attached❑ Detached❑ CARPORT sq.ft. Attached 4
MANUFACTU ION: *4 COPIES OF THE FLOOR PLAN REQUIRED*
MAK MODEL EAR LENGTH
IDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
SEWAGE/SEWER SOURCE: SEPTIC SEWER❑ / NEW❑ EXISTING
PLUMBING IN STRUCTURE? YES)l NO ❑ If yes, attach completed Water Adequacy Form
PERIMETERMOUNDATION DRAINS PROPOSED? YES ❑ NOV EXISTING SQ.FT.
EXISTING BEDROOMS PROPOSED BEDROOMS 42 TOTAL BEDROOMS 3
OWNER acknowledges that 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 and I further declare that I am entitled to receive this permit and to do the work as proposed.1 have
obtained permission from all the necessary parties,including any easement holder or parties of interest regarding this project. The owner or legal
representative,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 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 ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERMIT APPLICATION OF 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED. (MASON
COUNTY CODE 14.08.42)
X
Signature of OWNER(Must be signed by the OWNER) Date
DEPARTMENTAL REVIEW APPROVED DATE DENIED DATE TAGS/NOTES/CONDITIONS
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC HEALTH
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