HomeMy WebLinkAboutBLD2002-01009 Pier Ramp Float - BLD Permit / Conditions - 4/8/2003 Inspection Line(360)427-7262
MASON COUNTY DEPT. OF COMMUNITY DEVELOPMENT Phone: (360)427-9670,ext.352
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Mason County Bldg. 3 426 W. Cedar P.O. Box 186
Shelton, WA 98584
RESIDENTIAL BUILDING PERMIT BLD2002-01009
OWNER: ALBERTA TEFFT RECEIVED: 8/1/2002
CONTRACTOR: LAKESHORE CONSTRUCTION 275-5029 LICENSE: LAKESC155JA EXP:4/1/4200 ISSUED: 4/8/2003
SITE ADDRESS: 10991 E STATE ROUTE 106 UNION EXPIRES: 10/8/2003
PARCEL NUMBER: 322254100042
LEGAL DESCRIPTION: E 50'TR 4 OF GOVT LOT 1 &T.L.
PROJECT DESCRIPTION: DIRECTIONS TO SITE: p���L & VOID BY`EXPtaATiON
PIER, RAMP, FLOAT STATE ROUTE 106 TOT7E ADDRESSqWATE_P E.
4TE
General Information Construction &Occupancy Information Square Footage Information
No.of Bedrooms: Type of Constr.:
Type of Use: SF Insp.Area: No. of Bathrooms: Occ. Group: Lot Size: Deck:
Type of Work: ACC Fire Dist.: 6 No.of Stories: Occ. Load: Building:
Valuation: Building Height: Occ. Status: Primary Basement: pier/dock 1,126
Manufactured Home Information Setback Information Shoreline& Planning Information
Make: Length: Ft. Front: S 85.0 Ft. Shoreline: Ft. Water Body:
SEPA?: Yes
Rear: N Ft. Slope: Ft.
Model: Width: Ft. Side 1: E 47.0 Ft. Shoreline Desig.: Urban
Year: Serial No.: Side 2: W 72.0 Ft. Comp. Plan Desig.: Rural
Plumbing Fixtures Mechanical Fixtures FEES
Type Qty. Type Qty. Type By Date Amount Receipt
Plan Check Fee KLW 8/1/2002 $136.00 60087
Planning Review Fee PBC 8/20/2002 $38.00 62422
Building State Fee RLS 3/25/2003 $4.50 62422
Building Permit Fee RLS 3/25/2003 $223.25 62422
Total $401.75
BLD2002-01009 Please referto the following pages for conditions of this permit. 1 of 5
-- CASE NOTES FOR
BLD2002.01009
CONDITIONS FOR
BLD2002-01009
/ This application is s eject to Buffer and Landscaping requirements as established under Mason County Ordinance
Contractor registration laws are governed under RCW 18.27 and enforced by the WA State Dept of Labor and Industries,Contractor Compliance Division.
There are potential risks and monetary iiabili4as to the homeowner for using an unregistered contractor. Further information can he ohtained at
X 800-647-0962.The person igning this condition is either the horneowrrer,ardent for the owner or a registered contractor according to WA state law.
The use, handling and storage of hazardous materials or flammable and combustible liquids in excess of 10 gallons :snot allowed without the approval of
the Mason County Fife Marshal. X —4LZ-�E2
Provisions for surfacetsubsurface drainage control must be implemented with new construction or development on site and MUST NOT adversely impact
adjacent parcels. Under the requirements of Mason County Storrnwater Ordinance,either private ditches and drains will meet requirements of the
storrnwatef ordinance or prior approval will be granted to use an exis','mg utility and drainage easement dedicated for that specific purpose. For further
information regarding this ordinance and the REQUIREMENT to obtain an ACCESS PERMIT for the installation/construction of a driveway or access
connecting from a Masor,County Road, Contact the Maser County Public Works Department prior to construction at Ext 450. For any construction which
is proposod to be located within 25'of a Mason County road right of way, it is suggested to contact that office to review future planned work which may
affe✓-t your projpct.
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"lease sign, date, Initial all
conditions and mall back
to me.
- --THAW YOU
BLD2002-01009 VC8;0 reforta tho toCrnving pages for conditfons of the pemiit. 2 of 5
`Subject to conditions of shoreline permit no. shr2002-00004 as follows:
1.The pier,ramp,float and associated moorings shall be located to avoid shading of eelgrass and other aquatic vegetation, x 4x"C=_��03
Flotation for the structure shall be entirely enclosed and contained to permanently prevent the breakup or toss of the flotation material in the water
x _ 001
3. Debris or deleterious material resulting from construction shall be removed from the beach area and project site end shaK not be allowed to enter
waters of the state. x___ __ -f
4. Water Watily is not to be degraded to the detriment of the aquatic environment as a result of this project. x
5. Recreational piers shall be no higher than 11 feet above mean higher high water. Piers and docks shall have,at Least an eight foot span between
Pilings.x_'&?:Y_41 10-3
6. The surface of f[dating straciures shalt be a minimum of Bird,ht inches shove the water.x_ _ � 03
7. All floating structures shall include intermittent supports which run parallel to the shoreline to keep structures off the tidelands at low tide.
x�--LL—"/03
8. The applicant shall ob!ain a Mason County Building Permit and all other necessary state and federal permit approvals prior to the start of the project.
9.The total length of the proposed project shall not extend waterward further than either 115 feet or minus 5 tide,whichever is more landward.
x- ht - 3
10, Prior to building permit af}proval, the owners of the p, cels shall record an agreement for joint use of the dock reviewed under Shoreline Permit
#SHR24i✓2-00004,fd use of parcels 32225-41-00040 and 32225-41-00042,and provide a copy of the recorded document to Mason County planning.
6 Floatation for the structure shalf be entirely enclosed and contained to permanently prevent the breakup or loss of the floatation material into the water.
7) Water quality is net to be Pe to the detriment of the aquatic environment as a result of?his project.
X A"Ytd_
8 The surface of floating structures Shall!be a minimum of eight inches above the surface of the water X_ L a 3
BL02002-01009 Plea so referto tha(ollowicg pages for mriditlons of:his parmR 3 of 6
9) Proper erosion and sediment control practices must be used on the const uction site and adjacent areas to prevent upland sediments from entering
shoreline waters. Erosion control measures must be in place prior to any clearing,grading, or construction. These control measures must be effective to
prevent sal from being carried into surface water by starmwater ntnoff. Sand,silt,and soli will damage aquatic habitat and are considered pollutants,
Any discl►arge of sediment-laden runoff or other pollutapollutants to waters of the state is in violation of Chapter 90.48 RGW,plater Po luton Control, and
WAC 173-201A, Water Quality Standards for Surface Waters of the State of Washington,and is subject to enforcement action. Any work in or adjacent
i to waterways that will adversely affect waiter quality must receive speclfle prior authorizaWn from the Department of Ecology pursuant to WAC
173-201A-110. A short-term water quality standards modification maybe issued if the proponent agrees to a number of specific construction practices
and techniques designed to minimize water quality impacts. All areas disturbed or newly created by construction activities must be revegetated using
bioengineering technic{ues, clean durable 6prap,or some other equivalent type of protection against erosion when other measures are not practical.
X_
10) All upland areas disturbed or newly created by construction activities shall be seeded, vegetated or given an equivalent type of erosion protection(sli(
fencing or straw matting).X ,4/_ �_ _
11) All construction and demolition debris must ba rernoved from the beach after project completion. Proper disposal of ,onstruclion debris must be on iand
in such a manner that debris cannot enter or cause water quality degredation of State wafers. X �
12) All new treaied piling to be used for this project shall receeve a post treatment vacuum of two hours at i-iot less than 22 inches of mercury. Subsequent to
releasp of the vacuum, the piling shall be steamed for a two hour period,followed by a second vacuum of four hours at 22 Inches of mercury.
13) Temporary erosion control measures must be implemented to prevent water qu lity degradaat19n of adjacent waters or wetlands, Silt fencing must be
installed and maintained until uplana vegetation has become established- X vfl6 3 __-
14) Dock facilities must be maintained in a safe and sound condition. X /fiG(-
15) Approved per dimensions and seibacics on submitted site plan.X g p
10) All other necessary permits from Mason Couf+ty,Washington State and/or Federal Agencies that are required for this proposed developiment and
concUur.tion must be obtained PRIOR TO SAME DEVELOPMENT AND CONSTRUCTION. X�_�/ o
17) All approved plans are required to be on-site for inspection purposes, if an inspection is called for and plans are not available on site,then approval will
not ix;granted. In addition, a re-inspection fee(refer to current fee schedule,minimum 1 hour)wJI be charged and must be collected by the Building
Department prior to any
rher inspections being performed or approvals granted.
is) In accordance with the Uniform Building Code, aft sites shall have approved numbers or addresses located in such a position as to he plainly visible and
legible frorn the street or road fronting the property, Mason County Building Department requires that this be completed prior to calling for any site
inspecfons. A re-inspection fee based on rates as adopted by the jurisdiction and the Uniform Building Code will be assessad if the owner and/or
contractor
ntract�I to post lh address on site prior to requesting inspections-
19) THE FOUNDATION SYSTEM SHALL BE PLACED ON UNDISTURBED,NATIVE SOIL.X
BLD2002-01009 PkmwrefertoftfolkwAngpagestcfoonditionsof this permit- 4 of 5
" 20) The"approved"plot plan is required to be on-site for inspection purposes. If an inspection is requested and the"approved"plot plan is not on site, then
approval will not be granted. In addition, a re-inspection fee (refer to current fee schedule,rninimum 1 hour)will be charged and shall be collected b;the
Ruilding Department prior to any further inspections being perforated or approvals granted.
X
21) Any changes in proposed construction shall be reviewed by iho engineer or architect of record and submitted in writing to the Mason County Building
Department prior to constriction. All engineering andlor architectural documents are a part of the approved set of plans and shall remain attached
thereto. If 4ocurnents are removed, approval will not be granted. In addition,a re-inspecCron fee(refer to currant fee schedule,winirnum 1 hour)will be
chargoo and shall be le ed by the Building Department prior to any further Inspections being performed or approvals granted.
X - -4"
22) All construction must meet or exceed all local ordinances and the 1997 Uniform Duilding Code requirements as adopted and amended by Mason County
and the State of Washington. Occupancy is limited to the approved and permitted classificabon, Any non-approved change of use or occupancy would
result in errnit revocatloc.
X tr-7 --C_ o
231) Ail changes to"approved" building plans that effect compliance with the Uniform Codes as amended and adopted, or any other Mason County ordinance
or regulation, roust be re ved and approved by Mason County prim to rsonstructlon.
24) The construction of the permitted project is subject to inspections by the Mason County Building Department All construction must be in conformance
with the Uniform Codes as amended and adopted by Mason County. Any corrections, changes or alterations requirod by a Mason County Building
inspector be made prior to requesting additional inspections.
X L—
25) All building permits shag have a/ fir;ai inspection performed rid approved by the Mason County Building Department prior to permit expiration. The faituro
to request a final inspection or to obtain approval will be documented in the!egaf property records on file with Mason County as being non-compliant with
Mason County ordinances and uilding regulations,
X- �--�/g�3----
26) All perro its expire 180 days after permit issuance,or 180 days after the last inspection activity s performed. The Buildirip Official may extend tVie time for
action for a period not exceeding 180 days, upon the receipt of a written extension request ifidicatwry lfraf circurnstarx es b+,�vorrd the control of'.tre permit
holder have prevented ction frorn being taken. No more trian one extension may be granted.
X-- —
This permit becomes null and void it work or construckm authorized is rat commenced within 1F0 days,or tf coristructtan or vmrk is suspended far a pedal of 180 days at any @me atter wok is
cornmercad_ E.^dance of oontfnu n o work is a ras nspection within the 180 day pa�iod. Final inspeciicc must be approved before building can tie o(X%X,ied.
OWNER CR AGENT: _ _ DATA,___W
BLD2002-01009 Please refer to the Wrmnng pages for coi0t;ons of this permit. 5 of 5
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Date By INSULATION Date By
B G / Slab Insulation Floors Final
Date By Date By Date By
FRAMING Walls FIRE DEPT
Date By Date By Date By
PLUMBING Attic OTHER
Groundwork Date By
Date By WALLBOARD NAILING
D.W.V. Date By
Date By FINAL INSPECTION
Water Line Date By
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App.by Jane McCormick and Alberta Te$I
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x In:Hood Canal near Union,Mason County,
Q. an` 1 - -,_ WA
` I1B` � � s Pu Construct new ier,ram and float
Datum:MLLW
_= Adjacent Property Owners:
�.rV 1)J.Stanford&Diane Bailey s
., 2)Nathan&Evelyn Cox
Sheet 1 of 4 Date:January 15,2002
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Reference: o
CV ': / /f/ � / %rl,` f App.by Jane McCormick and Alberta Tefft N
In:Hood Canal near Union,Mason County,
WA
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Purpose:Construct new pier,ramp and float
!A- ( Datum:MLLW
Adjacent Property Owners:
f 1 J.Stanford&Diane Bailey
McCormick and Tefft Project Location: r. �'. / � ^ � � ) Y
2)Nathan&Evelyn Cox
Section 25,Township 22N,Range 03W '/ V
10991 E.Highway 106 Union,WA 98592 a
Y 1 f_ Sheet 2 of 4 Date January 15,2002
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123001'00"W V 123000'00"W WGS84 122°59'00"W
TN /MN
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6'x 20'FINGER FLOAT
MHHW= 11.8'-°--
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6'x 34'FLOAT 4'x 40'RAMP 6'x 39'PIER
PQ ® = STUB PILINGS ATTACHED
TO FLOAT EXISTING BULKHEAD
HOOD CANAL NORTH
Materials:
Pilings- 11 ACZA treated class B,Douglas g g Reference:
fir App.by Jane McCormick and Alberta Tefft
Floats-4,ACZA framing lumber,flotation is In:Hood Canal near Union,Mason County,
polystyrene foam enclosed in polyethylene WA
resin shells Purpose:Construct new pier,ramp and float
Pier-ACZA framing lumber,galvanized Datum:MLLW
fastenings Adjacent Property Owners:
Ramp-pre-fabricated aluminum 1)J.Stanford&Diane Bailey
2)Nathan&Evelyn Cox
Construction and site details are contained in
the project Biological Evaluation Sheet 3 of 4 Date:January 15,2002
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MHW= 10.9' --"'HW= 11.8'_
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EXISTING BULKHEAD
MLLW=0.0'
-3.0 Tide line �-_
\STUB PILINGS
Reference:
App.by Jane McCormick and Alberta TeM
In:Hood Canal near Union,Mason County,
WA
Purpose:Construct new pier,ramp and float
Datum:MLLW
Adjacent Property Owners:
1)J.Stanford&Diane Bailey
2)Nathan&Evelyn Cox
Sheet 4 of 4 Date:January 15,2002
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Figure 5. Float stop collar details
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McCormick Teffi Pier,Ramp&Float Project•25
Figure 3. Typical construction details of pier and float 2 x 6 TOP
CAP
- FENCING
2 x 6 DECKING P.T.
1/2 x 8 \ 1/2" DRIFT 4" x 1/2" -
GALV. PINS P.T. STRINGERS \
BOLTS
6x8CAP P.T.
10" - 12"
CLASS B CHEMONITE PILE
TYPICAL 20 FLOAT SECTION
TOP
4" x6" /
PROTECTED ANGLE
UN GALV. ALL
4x 8
6" /STRINGERS
— 2" x 6" SLEEPER 4
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FLOAT
DRUM 1/2" x 4"
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I GALV. BOLTS
4 PER ANGLE
2" x 6"
DECKING
ALL LUMBER 1S PRESSURE TREATED
ALL HARDWARE IS HOT DIPPED GALVANIZED #1 DECKING
SIDE
4" x 8" P.T. ,3/8"x 4"
LAGG
FLOA DRUD V V V v V 1/2" x 18"
GALV. BOLT
— 4x8
2"x6" — 4 x 8
SLEEPERS
McCormick Ted Pier,Ramp&Float Project•23
' 1 pN_STA'k MASON COUNTY
C �� DEPARTMENT OF COMMUNITY DEVELOPMENT
s° "= Planning Division
N Y P O Box 279, Shelton, WA 98684
(360)427-9670
1864
NOTIFICATION OF INCOMPLETE APPLICATION
August 20, 2002
ALBERTA TEFFT
2526 98TH AVE NE
BELLEVUE WA 98004
Parcel No.: 322254100042
Project Description: PIER, RAMP, FLOAT
Dear Applicant:
You have submitted a permit application (case no. BLD2002-01009) for proposed construction or
development in the county. Upon review of your application, I have determined that the contents of
the application are incomplete or do not provide enough detail for review.
Therefore, review of your application will not proceed until the necessary information is provided (see
the comment section of this letter for details.) Once the information is submitted and the application is
complete, I will continue to process your application accordingly.
Please contact me at (360)427-9670, ext. 295 if you have questions.
Sincerely,
Pam Bennett-Cummina
Land Use Planner
Mason County Planning Department
8/20/2002 1 of 2 BLD2002-01009
NOTIFICATION OF INCOMPLETE APPLICATION
8/20/2002 Case No.: BLD2002-01009
Comments: It was a condition of the shoreline permit for this project that a joint use
agreement be recorded on both properties.
Condition #10 of Shoreline permit #SHR2002-00004:
10. Prior to building permit approval, the owners of the parcels shall
record an agreement for joint use of the dock reviewed under
Shoreline Permit #SHR2002-00004, for use of parcels
32225-41-00040 and 32225-41-00042, and provide a copy of the
recorded document to Mason County planning.
Please provide a recorded copy of your joint use agreement for the
dock. The document will need to be recorded on both pieces of
property because the dock was allowed with extra length because it is
for joint use and will be located on the joint property line.
8/20/2002 2 of 2 BLD2002-01009
FORM MUST BE COMPLETED IN INK
PERMIT NO.: BLD t9
PLEASE PRESS HARD MASON COUNTY
BUILDING PERMIT APPLICATION nn
d�
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 A L13ERTA TFFFT I.TANE Me oi2MlClt Contractor Name 7/ Z�Ztf Gr4KtS�hf ( 7.
Mailing Address 2 5 Z(v 9 6 TH jVE. NE Mailing Address PO EM 105-6
City BELLE VUE State W/f _ Zip Code `l SOON- City State NA Zip Code dSL
Phone( ZS )L -5`f�-lpG} �1
5 Other Ph.( 25 j�9`6-3�{(o! Ph.( 3Go ) 2 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 Water System Name of
Water System
PARCEL INFORMATION- d�git T arcel / / L Fire District ly
Legal Description It
Site Address(Please inclu a street name, streetnu r and city) ION WA
Directions to site D
Will timber be cut and sold in parcel preparation? (Yes/No) NO
Is your property within 200' of the following: Body of Water(Name) HOOD (A,yA L_ 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 PIER RAM Q AND FL o67- //V55TA LAT-1 oN 6-48 =Z88 2-61Z0= 1 6z3y=
No. of Bedrooms o of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor,
3rd Floor Loft Basement Deck Other yX`40 I&D /(40
Garage Attached Detached Carport Attached Detached IoZ(p
MOBILE 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 e ' e If,represents that the
information provided is accurate and grants employees of Mason County access to the above described prope r�riteicite€f�r review and
inspection of this project. Acknowledgment of such is by signature below: v
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify tifim S"1'tl2�/�tered 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 tfifie ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the work for I� h�p er i ss,tty�e and all work
conformance therewith. No anges shall be made without first obtaining shall be done in conformance therew' ch'mgi ASK�lL-without
appro first obtaining approval.
X Date Z- X Date
FOR OF I IAL('UUSSEt BEYOND THIS POINT/
Accepted by I l�-Ll/ Date ����`g'u�mittal Amount Due / l0� Receipt No.(��
DEPARTMENTAL.REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Group Type Constr. CaSPS SJE 2002-- 0001
Planning Department SOP,2.00Z - 0000 4/
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
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 ��0 Pre-Paid at Submittal ( )
TOTAL FEES
PERMIT NO.: BLD=
MASON COUNTY
BUILDING PERMIT APPLICATION JUL 15 200Z
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 "IG AlrCinjeA:tlC/ Contractor Name U4uhSrh2F �
Mailing Address AVE NE Mailing Address St
City, ELr F I,li.tr State Zip Code 7 rO4 City State 'r',4 Zip Code
Phone(, )1. � Other Ph. ± � ,17% - 3!{(01 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 Water System Name of
Water System
PARCEL„JNFORMATION-12 digit Tax.Parcel / / Fire District
Le"gal Description
Site Address(Please include street name, street nu r and city) 4Q ar) IS, t.l N 100 WA
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)_�Q_
Is your property within 200' of the following: Body of Water (Name) HDOE) CAluA Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
PERMANENT RESIDENCE❑ SEASONAL RESIDENCE 0
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work h- r r, r r1 A I R 4 41bF1 ra T 4 T)ni\l H,,i( - Z�,b Z -l6),20 - MID AOX3`1=2
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor `ID
3rd Floor Loft Basement Deck Other `!y I-IC I
Garage Attached Detached Carport Attached Detached H 1
MOBILE 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 pry�p y�r d structures for review and
inspection of this project. Acknowledgment of such is by signature below: �1//,,\\�� 1C.r VVEE D
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certif at I m currentl registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washingtor. Ihan*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 perms is sued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance they~����i W cf all be made without
approval. first obtaining approval. ~! `C STD
X Date 4/ f> X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by ' ' t f ' Date Submittal Amount Due Receipt No.�'z�i�L✓
i
DEPARTMENTAL.REVIEW APr'VpvED �NlED < CONDITION COPES
Building Department
Occ Group Type Constr. @ 5 ("OSIP5 SEP2002--
Planning Department $J I12 20cZ - 0000 c/
Environmental Health Department
Public Works Department
i
Fire Marshal
Valuation $
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
PERMIT NO.: BL
C42.0wul
MASON COUNTY RECEI VL0
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 Seattle 206 464-69681JU`1 it
APPLICANT INFORMATION CONTRACTOR INFORMATION 426 W. CEDAR ST!
Owner Contractor Name
Mailing Address Mailing Address
City State Zip Code City State Zip Code
Phone( ; ) Other Ph.O 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 Water System Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. / / I. Fire District
Legal Description
Site Address(Please include street name, street number and city) wir" t.,VA
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 0
TYPE OF JOB New Add Alt Repair Other Use of Building
Describe Work T W
No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nclFloor
3rd Floor Loft Basement Deck Other /64 /6
Garage Attached Detached Carport Attached Detached I f ,
MOBILE 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. Acknowledgment of such is by signature below:
�C
OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 certify th��aVEDtly registered as a
Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washj a 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 wor&hi is�t is issued and all work
conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No cha shall be made without
approval. first obtaining approval. 426
. Wj CEDAR ST>'
X Date X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTMENTAL'>REVIEW APPROVED DENIED CONDITION CODES
Building Department
Occ Group Type Constr. ���SG , F r� L• G
Planning Department fJk; '2002
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
FEE$>
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