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HomeMy WebLinkAboutCOM2004-00141 Final Phase of Permit COM2001-04003 - COM Application - 6/24/2004 MASON COUNTY q-w1 BUILDING PERMIT APPLICATION 426 W. Cedar• P.O. Box 186, Shelton, WA 98584 0 i� f&k� t�4� ` ^,! � w Shelton (360)427-9670 • Belfair(360)275-4467 • Elma (360)482-�269 a On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner �c((_ Contractor Name Mailing Address Mailing Address C►i r. City k�k-\-AF-A I(LL Statet-..A. Zip Code T_'X City ,e �-��,n/" State Zip Code Phone 7 - ther Ph t.., -C Phone? (il ther Ph. Lien/Title Holder P lA Contractor Reg. # Qp. 6 Email Address Email Address SEPTIC /WATER SYSTEM INFORMATION -Connect to New Septic Existing Septic . Connect to Sewer System Name of Sewer System Well Water System 777 Name of Water System ; . @ 1 iiVj PARCEL INFORMATION - 12 digit Tax Parcel No. 2 75": 2__ / 0 / C0©Crl Fire District Legal Description Site Address (Please include treet name, stre t number anrl city) -�-- Directions to site t�e?._t �+`C CJS= H `:'-*�kt,JO--` ► iAr��.. t 1 vti `� Will timber be cut and sold in parcel preparation? (Yes/No) Is property located within 200' of 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 Is this permit submittal the result of a Stop Work Notice, Correction Notice or other enforcement action?(Yes/No) n Describe Work T 1A a 1 0%t, C O,{ P4((-4 l�f ti 2-c© No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE- 1st Floorr_ 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MANUFACTURED HOME INFORMATION - Make Model 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. 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. OWNER/BUILDER ACKNOWLEDGES SUBMISSION OF INACCURATE INFORMATION MAY RESULT IN A STOP WORK ORDER OR PERMIT REVOCATION. ACKNOWLEDGEMENT OF SUCH IS BY SIGNATURE BELOW: OWNER AFFIDAVIT- I certify that I am exempt from the require- CONTRACTOR'S AFFIDAVIT- I certify that I am currently regis- ment of the Contractor Registration Law RCW 18.27 and am aware tered as a contractor in the State of Washington and that I am aware of the ordinance requirements for which this permit is issued and of the ordinance requirements regulating the work for which this that all work will be done in conformance therewith. No changes permit is issued and all work shall be done in conformance there- shall be made without first obtaining approval. with o cha ges shal a ad without first obtaining pproval. X Date X Date 2 d FOR OFFICIAL USE BEYOND THIS P INT Accepted by y Planning Pdcil `\ 'Ck# Date �0 Bld Pd. (r7 Jr� Reciept No. DEPARTMENTAL REVIEW, ' �R x D DENIED. "A QN©IT,dC�s Building Department l Occ GroupT e Constr. Planning Department 2 4 Environmental Health Department 426 w, Public Works Department AW Fire Marshal Valuation $ IF FEES Building 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 TOTAL FEES MASON COUNTY Dept. of Community Development Mason County Bldg. 3 426 W. Cedar P.O. Box 186 IP14 Shelton, WA 98584 Notification of Permit Cancellation December 09, 2005 LESTER KRUEGER BOX 548 BELFAIR WA 98528 Case No.: COM2004-00141 Parcel No.: 123325000007 Project Description: FINAL PHASE Dear Applicant: Upon review of our records,the Mason County Permit Assistance Center has identified that your building permit application has been approved and ready to issue or placed on hold since 12/9/2005. Once approved or placed on hold, permits are valid for 6 months. If you intend to obtain this permit,you must make arrangements to do so within ten (10)working days from the date of this letter. If we do not hear from you within the that time, your permit will be cancelled and a building inspector will make a site visit. In the event that your project has been completed and a permit was never issued,you will be assessed penalties as allowed under Mason County Title 14 and Mason County Title 15 If your project has been cancelled or if you wish to withdraw the permit, please notify me as soon as possible at(360)427-9670, ext.616. Thank you for your cooperation. Sincerely, Jug � Con tic Charell Holcomb Mason County Department of Community Development AqAl 'J &6sr'6n On W hth� � 5 Clifton Ridge PLANNING Prop«ty Lynx. ................".._..-..-._._.------ nzDrorenren'ermng__._.______r_____e_..__.__._ apa.a,a Parmlr fit, . 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AJplWt raving ti dd 0 11 -y I I --SepWx:Tnnkt�n porb� a� I I i� PCYyy hdv(e hzle badJ }Vt irat(MJ part) Extspftr a�fnd vela ed A g�xwva °ed bank I I � Afphelr Panrg J I I I i.6LeLTC § I I I alai sc 7 ca :U 23--rtVrity 60.0 It'•0• Ig'•I1,6' W-W 2014- - S+e Srem..prem tus<a on GwlpMa6y athevs /� dge of sapric pot tion L ' ramfield Ar To Gorst/Brr�neman I See specific gsign / American Engineering Corp. - I o Ph&se tTe � North Shore I e I u Belfair Probe,Site _ -.... -.__ . ocation:Belfair,Moon County,WA m NE-1/6,Sec1.32,T.23Ni1.iWMM Assessor's Account No. 12332.50.00007 6 0002 N u Parcel A per boundary adjustment o / Comprehensive Plan:Belfair Urban Arm '^ I / Project Address: 30 NE Romance Hill Road . Belfair,WA 98528 Clifton Ridge / Site Boundaries: Boundaries and datum based an N - data by Michael Wnek,PE N Schematic Site I La o [ Vicinity Map10f1 10 0 NTS APPROVED MASON COUNTY DCD PLANNING SITE N REQUIRED TO BE ON SITE CHPN ES SUBJECT TO APPROVAL By UL Date! / t