HomeMy WebLinkAboutCOM2007-00051 Cancelled Bunkhouse #2 - COM Application - 5/11/2007 .. . MASON COUNTY PER T NO.�V_ Ir. l
FORM MUST BE COMPLETED IN..
PLEAS S;), t-II RDI IT61LDING PERMIT APPLICATIOIN�I'1�
?- 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
APPLICANT INFCiRMATlO CONTRACTOR INFORMATION
Owner Cra ;was ; {}{�►�-�� Company Name
Mailing Address Mailing Address
City LA—z - 0ila:: State U24 Zip Code`laic, I City State Zip Code
Phone 25-- 1e1+ Other Ph. Phone Other Ph.
Lien/Title Holder_. Contractor Reg.# Exp.
E mail address C�.�e' �,4 1 sii:�( d° E Mail Address
Drivers Lic.# P ' i'. `4i t31� DOB 1 s s Drivers Lic.# DOB
SEPTIC/WATER SYSTEM INFORMATION - Connect to New Septic � Existing Septic
Connect to Water 113yste m Name of Water System
Weller Sevier System Name of Sewer System
PARCEL INFORMATION - 12 Digit Parcel No. 3 Z 00 Fire District
Legal Description_ � 1 _> '=� a4 .9i �'
Site Address (Plea,,e irnaude street name, street number and city) q9l ,3 � 4t-�'.y � `-' `I
Directions to site rryo:1 `i.1sc�7'�, J c'� i h1"' y ( -�rK �� r T�vz t_ f% C t ►�k_ Z 21
Will timber be cut and sold in parcel preparation?
Is Nt� River/Creek Pond
property �t'� ` _
p p y within L Lake Slopes or Bluffs 15% N y } ��'
Wetland_•�_,.Seasonal Runoff �� Stream L�3`r.
Is this permit submittal the result of a Stop Work Notice,Correction Notice or other enforcement action?Yes/No
TYPE OF JOB - Neer ✓ Add Alt Repair Other PRIMARY RESIDENCE ❑ SEASONAL ❑
Use of Building__ G,2-4AP Describe Work 1-'
No. of Bedrooms,..— No. of Bathrooms Square Footage- 1 st Floor 33110 2nd Floor
3rd Floor .—Basement Deck Covered Deck Other Sq. ft.
Garage ._ Attached Detached Carport Attached Detached
MANUFACTUREED 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 Ackn Dwledges 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 permission from all
the necessary parties. If permission is required from any easement holder or any other party in interest regarding this application or the work
proposed in the application, I have obtained permission from them to apply for this permit and conduct the work proposed. The owner or
agent on owners behalf, re xesents that the information provided is accurate and grants employees of Mason County access to the above
described property and structure for review and inspection. This permit/application becomes null & void if work or authorized construction is
not commenced within 180 days r if construction work is suspended for a period of 180 days.PROOF OF CONTINUATION OF WORK IS BY
MEANS OFAPROGRI_SS IIJSPE INACTIVITY OF THIS PERMITAPPLICATION OF 180 DAYS WILL INVALIDATE THE APPLICATION.
X _. . A. Date: 'Ck C'1
Owner/Owners F2eprese alive!Contractor (indicate which one)
FOR OFFICIAL USE BEYOND THIS POINT Accepted by: Date
DEPARTMENTAL. REVIEW APPROVED DENIED NOTES
Building Department
Planning Department
Environmental Heall:h De partment
Fire Marshal
FEES
Building Permit Fee: Site Inspection
Plan Review Fee EH Review Fee
Plumbing & Base Fee Planninq Review Fee
Mechanical & Base fee Other
Wood/Gas/ Pellel Stove Fee State Fee
Violation Fee Pre-Paid at Submittal
Valuation $ .� TOTAL FEES