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HomeMy WebLinkAboutBLD2003-00050 Cancelled Shed - BLD Application - 1/21/2003 427-9670 MASON COUNTY BUILDING DEPARTMENT ALL PERSONS ARE HEREBY ORDERED TO AT ONCE TOP WORK On these Premises at This order is issued because A.M. Posted P.M. 19 By The failure to stop work, the resuming of work without permission from the WARNING Building Official,or the removal, mutilation,destruction or concealment of this Notice is punisha fine and imprisonment. �(D n E Te& L Yep, c nj--* 3aaoa - -God+3 - A .� t _ ss / Z- 2 Tom' �. Tx T�. FORM MUST BE COMPLETED IN INK F `J PERMIT NO. PLEASE PRESS HARD MASON COUNTY 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)464-6968 On the Web www.co.mason.wa.us APPLICANT INFORMATION CONTRACTOR INFORMATION Owner RG(?A L /5/Jn O L, k", L Contractor Name Mailing Address fc, Ni, t'£_£ LAIZL 011\0 Mailing Address City 4#gF 4i1 State Zip Code J,'S bii City State Zip Code Phone ' •c i)L-zso 2 Other Ph. L—J Phone Other Ph. L_J Lien/Title Holder Contractor Reg.# Exp. E-mail Address E-mail Address SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System_Name of Sewer System Well Water Syst�ern Name of Water System PARCEL INFORMATION - 12 digit Tax Parcel No. 3Z2.c 2- / S I9Ccy 3 Fire District Legal Description i n {' d(•Dw\ UO 5412vv1-c llo R Ffuc,, 1rS sub ono Site Address (Please include street name,street number and city) t�`'� ��' r c `/`r' �``' ' Z'', z.Z"'_a, }`"•Q:PA _ Directions to site r116,tit 6 LtJ4I\Z ,itl1,�k n. ;.\ 1 rx o .RV. tkL�Ufi iTl�LLAV4• Zoe , e , c it ( L <NK( _ IZTo,', %LLLNCt" P! t 5 oot LXL.A .4ti-, 17 , Will timber be cut and sold in parcel preparation? (Yes/No) (1C S Lake River/Creek Pond Wetlan '� Seasonal Runoff Stream Slopes or Bluffs • PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB- New Add Aft Repair Other Use of Building Is this permit _ S o or e, rection Notice or other enforcement action (Ye l/No)��eS D cribe Work ;[6 kA C"-4. 5 N[ No. o e OUARE FOOTAGE- 1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq.ft. Gamq6A Jc�l X Attached Detached 0 Carport 3 x�6 Attached �8 Detached 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 prope�r)3 �tu fF�► ew and inspection of this project.Owner/Builder acknowledges submission of inaccurate information may result in a stop work ordbt6rp rfil[ e o -lion.Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a the Contractor Registration Law RCW 18.27 and am aware of the ordi- contractor in the State of Wash* ni t I aM awarp of the ordinance nance requirements for which this permit is issued and that all work will be requirements regulating the�6bAc�for i '�W4-p6rrrd?is issued and all done in conformance therewith. No changes shall be made without first work shall be done in conformance therewith.No changes shall be made obtaining approval. without first obtaining approval. X n' " �,� Date X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date r/5 03 Submittal Amount Due Receipt No. © � nrrA>_REVIEW ApPROVF� ENIEEl.'' £ h cc►I�lom,,c�M u>.� Building Department _ Occ Group Type Constr.' rJ EtvF`' n© Planning Department Environmental Health Department IL 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 Pre-Paid at Submittal ( ) "'" - TOTAL FEES