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HomeMy WebLinkAboutBLD98-01035 Cancelled Storage - BLD Application - 10/27/1998 2 PERMIT NO . BLD `� 403S . 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 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner -5TEUE /V10Qn#J Contractor Name I-2.01k1- hENN1 Mailing Address Z-1 31 E M4-3aO^J I_C b IL e A,'�,'T" Mailing Address B C IS&J-104 IM City GQAAEU I State 1, k Zip Code °I$S4(a City 6aku16ti State Wei Zip Code `a Phone( y2-b 324(oOther Ph.( Ph.( &4ZG-S_)6_7 Other Ph.0 Lien/Title Holder ZAIA Contractor Reg. # DFNNYhJ 1`1Z's7 Address Expiration 0 1 / 27- / q 9 SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic V Connect to Sewer System Name of Sewer System Well V Water System Name of Water System PARCEL INFORMATION-12 digit Tax Parcel No. 222JS -.12- 4O063/ Fire District Legal Description IMA�tNb 100A)Y 511 rt..t:= Ab p to -t^2ACT (a3 Site Address(Please include street name, street number and city) Z.'1 31 Yh A Lr C-39N 4>T- GeAAEU IE- Directions to site NIWAy 3 -io m4:w J &tJ�WJ RZ ?D fkP0oA toIC.t kLtA6,b-r N Wow eIWr Will timber be cut and sold in parcel preparation? (Yes/No) AjO Is your ro erty within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB New Add Alt Repair Other Use of Building �i "6E I&)Ia4# Describe Work 32 XSiII6 S-Mf?AbC-BU iCb IN 6 No. of Bedrooms No?of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft 34 Basement Deck Other sq. ft. Garage // Attached Detached Carport Attached Detached MOBILE HOME INFO ATION-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: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-1 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 FOR OFFICIAL USE BEYOND THIS POINT Accepted by "! Date Submittal Amount Due � 1 I ' � ' Receipt No. � 7 DEPARTMENTAI»!!REVIEW APPROVED DENIED CONDITION COPES Building Den rtm t t / T ! . Occ GroupType Constr. /�1 \c/6 —� Planning Department Environmental Health Department Public Works Department I Fire Marshal Valuation $ �� i — 79�a FEES Building Permit Fee / Site Inspection Plan Review Fee / I UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other o0 W d/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( 194.941) Q OTALFEES T MASON COUNTY PROJECT SITE INFORMATION Case No. Name d AVZ44 PARCEL NUMBER LZ�-33—�� O©o6 3 Date 2-7le SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicdtiong N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line-> , , f-adjacent property line I , 1 , I , 'I I , I , I , 1 , I I I i 1 I , , I I i I I I 1 1 1 , , I I , I I I I adjacent property lined I <-adjacent property line SAMPLE SITE PLAN adjacent property line4Fadjacent property line �1 17 36' I RLS vc 3�1 ,SEAJSsZ%/A" i tt[[ fi CREEK A I Hone 6 -- I Car3�-1 1 1 60, pit I VAGAlT , 1 CrARAGt � I g° I D0.�POSCi� �• T A1R1CU.LfU-1XAL 50 i K—90-�I ,�• I I � 1 I I , 1 I i" •eLL /00 adjacent ro ert line4 c \; Fadjacent Propertyline TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE —MPd 6re�uy ��f1lC� s+ruttltiYG ,4 rrAGK diStlhLC to Slop= f o¢ dls+anca. +o Q .. .... ......... 0