HomeMy WebLinkAboutBLD98-00801 Cancelled Addition to Covered Porch - BLD Application - 9/4/1998 � PERMIT NO.: BLD
� t MASON COUNTY -Cool
BUILDING PERMIT APPLICATION gll
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
j Owner gob 6000 Contractor Name
Mailin$Address 3530 Clot Oe i, Mailing Address
City IS eI& I. f- State Wd_ Zip Code 9 17 SZ I? City State Zip Code
Phone 3( 60 )372-Z9yy Other Ph.(&Q )47ia3�1 Ph.( Other Ph.(�
Lien/Title Holder e It 4 Pea I+ 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 di it Tax Parcel No. Z L30y / "] / 90Z0 1 Fire District
Legal Description'tR SI-A o 5,,A r✓ I P 1 3y
Site Address(Please inclufcle str et nam , street num4e((and city) '101 kti 1 14 rv.
Directions to site O d Uek t r RW - Ief t ors gear Gre t - Ewa d
Tu a cks&, i FI, E - Ie + 1 .4w.; o
Will timber be cut and sold in parcel preparation? (Yes/No) �J O
Is your property within 200' of the following: Body of Water (Name) Saltwater
Lake River/Creek Pond WOO' Wetland Seasonal Runoff ✓ Stream Slopes or
Bluffs
TYPE OF JOB New Add 6/ Alt Repair Other Use of Building
Describe Work Gdd%Ti0►, ,o. QXiS4 00,r%! 1,Id g , 5FX IL0 COYP�f �Qr
No. of Bedrooms -&" No. of Bathrooms SQUARE FOOTAGE-1st Floor-S-'NW-2nd Floor -49-
3rd Floor Loft_ Basement $ Deck -19" Other t a S' sq. ft.
Garage Attached Detached Carport__±eK—Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial No. No. of Bedrooms No. of Bathrooms
Type of Heat Purchase P ice Replacement Unit ?(Yes/No)
Installer Name Certification No.
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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 X'V�� 4 Date ff-1 /e X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Dat��/- � Submittal Amount Due Receipt No.
DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES
Building Department A F- :K B-a -
Occ Group Type Constr. .t
Planning Department
Environmental Health Department
Public Works Department
Fire Marshal
Valuation $
F:1wES
... . . .
Building Permit Fee 00 Site Inspection c�
Plan Review Fee sec UFC Plan Review Fee
Plumbing & Base Fee Public Works Review Fee
Mechanical & Base Fee Other
Wood/Gas/Pellet Stove Fee Other
Vi I i In Fee Sly
00 Pre-Paid at Submittal ( )
................................
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TOTALFEES
FORM MUST BE COMPLETED IN INK tt�
PLEASE PRESS HARD MASON C ATY Opmi SITE INFORMATION
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tv I , Case No.
Name K6 0,R_QG'K5APQP, PARCEL NUMBER Date
SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg 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-) I uVei I Fadjacent property line
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SAMPLE SITE PLAN O�N�
adja1 nt property lined aio' Fadjacent property line
I D 30" r�RvE gel
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adjacent property line-;�
; Fadjacent ro ert' line
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
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Signature Date