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Home My WebLink AboutBLD2004-01616 Cancelled SFR/Garage - BLD Application - 12/1/2004 MASON COUNTY PERMIT NO. L C — BUILDING PERMIT APPLICATION PA* 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 APPLIC.rANT IN OR TION / CONTRACTOR INF RMATION Owner I'y ,r. � L rw Contractor Name ''C Mailing Address Mailing Address `e. City State,p[��Zip Code City State Zip Code Phone ( - (I 1 Other Ph. ( ) Phone ( - " th��,Lien / Title Holder Contractor Reg. / Email Address Email Address /U1-`.K_/,• SEPTIC /WATER SYSTEM INFORMATION - Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PARCEL INFORM Ip -N di it Tax P rc�No. �1 V Fire District Legal Description � � ✓' Site Address (Ple se ipClude street Y name, stye umber and city) Dir ctions to site 1 I( 1 - ( { Do t Q71 , t r Will t ber be cut and sold in parcel prepa tion? (Ye N Is property located within 200' of saltwater a River/ Creek Pond Wetland Seasonal Runoff Ste pes or Bluffs PERMANENT RESIDENCE SEASONAL RESIDENCE ❑ TYPE OF JOB - New V 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) Describe Work ! ,A I (+ 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 MANUFACTURED HOME I 9I�MI N - Make Model Model Year Length Widths 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, vvithblio,changes shall be made without first obtaining approval. X Date X V 1 Date i I C -f PE PM I (� FOR OFFICIAL USE BEYOND THIS POINT Ac ec d' I D Planning Pd Ck# �T 08 2004 Dat Bld Pd. Reciept No. 426 W.+ CEDAR ST., ��lQ�M4 4Q&X* REVIEW APPROVED DENIED CONDITION COPES Building Department Occ GroupType Constr Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ FEES Building Permit Fee 35 Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee Planning Review Fee Mechanical& Base Fee �y Other Wood/Gas/Pellet Stove Fee State Fee yb Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES MASON COUNTY PERMIT NO.: PLUMBING/MECHANICAL PERMIT APPLICATION 426 W. Shelton(360)427-9670/Beellf ir13606 �75467'Elma9 360►482-5269 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner `' G Contractor Name Mailingg Address Mailin Address City y,?� State 1AilA Zip Code City State Zip CodW� � Phone(_; -nuTOt er Ph.( Ph. _ — Other Ph.(� Lien/Title Holder Contractor Address Expiration SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION• 12 digit Tax Parcel No. / Fire District Legal Description Site Address(Please include street nam treet umber and city) Directions to site — Is your property within 200'of,the fo lowing: dy of Water(Name) I�� Saltwater Lake er/ ee Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet PLUMBING FIXTURES (Show Number of each) MECHANICAL UNITS Fuel Type: Electric !yDe of Fixture No.of Fixtures Fees LPG Natural Gas Heatpump Toilets Type of Unit No.of Units Fees Bathroom Sink Furnace Bath Tubs Heatpumps Showers Spot Vent Fan Water Heater Propane Tank Clothes Washer Gas Outlets Kitchen Sinks Wood/Gas/Pellet Stove Dishwasher Kitchen Exhaust Hood Hosebibs Dryer Vent Other Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 AFFIDAVIT4 certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 x Date 1 C -7-� FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. AEPAR?MENTAt[tE1l1E1N APPROVED DENIEf3 GONDf71(3N CODES Building Department Occ Group Type Constr. Planning Department Other Other SEES . ..... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Sul5rNttpl ( ) Violation Fee TOTAL FEES rX l PLOT PLAN Name er�`e p �14l1n� Go,? Mailing Address_ 81 erlonef oa S W4. '7656-q _ Home #3(a0-43a- O/// Wo k # Cell # Property Location YXX Uh DrI'ye 5Af1f0.A)4cyA• F6'$-F-4 Legal Address TS �;Z I 0 R 3 W Sec 3 O Tax Lot # 3a 13 0 7500140 _1k)1-9Son) County, State of W,+,S 8100-r0m,) THE INFORMATIONON T145 PLOT PLAN HAS BEEN PROVIDEI;Al-Ih REVIEWED BY 11ICI'I101'ERTY OWNER WHO BY 5I6IJING BELOW:i)ACKNOWLEDGES MJU ACCEP 15 FULL RESPOI r'IBILI rY FOR ITS ACCURACY AND COMPLETENESS.2)IS RESPOPI_I BLE 10 EI ISURF.I I IAT I IF / 160VEEK-ITAL O THE SITE TAKE PLACE IN COWF[NtMnt•KE WI II I TrRS PLnIJ.3)\VILI. E CORNER IRONS.LOT LINES AND CODE-REF,)VptFD SETBACKS PCt�1RAf:U OF SCALE: I = NY CHAFI6E(S)TO THI5 PLAN MUST BE PRE-AITROVED BY TI IE GENCIES WITH JURI5DI E MORTGAGE LENDER AND II IF DOCVMEN !� oa' P " UAI E � -!6 a OW R GNATURE DATE I � I ,EDLY-9-) 1 . PLANNING t APPROVED MASON COUNTY DCD PLANNING -Y' I SITE PLAN REQUIRED TO BE ON SITE �. <- G SUB CT TO APPROVAL ' I By , Date � I LO bO 2T M 40 � - I v � Ld o I I 5� 35