HomeMy WebLinkAboutBLD2001-01322 Final Cabin - BLD Permit / Conditions - 1/31/2003 v ,
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CORCRETE MECHANICAL MOBILE HOME
_ Ribbons
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date - ���Z- by Gas Piping date
Foundation Walls date 2 T�Z date Set U
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date by date by date by
FRAMING Walls FIRE DEPT.
date G., Z date (>
by //''�- L by Z date by
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Groundwork date v /�'c -) by T
date b WALLBOARD NAILING
D.W.V. " date �/ -� /L by 7- .
date �L �' FINAL INSPECTION &V-'
Water Line n r2
date 6 o-L by J ` , date /- 3 j -Oj by !�✓ date by
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PERMIT NO.: BLD Cl"� 3
MASON COUNTY Zla'1
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 AA y ... Contractor Name � ,� ,z y,...,e,M ,
Mailing Address tr `!t €" *yz 0i' Mailing Address a
City , }, _I� its State t%JA Zip Code � , s' City State Zip Code
Phone " ,; 21,1;-j,-7 Other Ph. , .>b y ..�:iy "� Ph.( Other Ph.(
Lien/Title Holder i�yyi r Contractor Reg. #
Address Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic_� _
xisting Septic _. Connect to Sewer
System Name of Sewer System :" tt1Iwe �1�t"���ystem Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. �.' �.cz1 `-,/ _ Fire District
Legal Description _' It HA ,4
Site Address(Please include street name, street number and city) y a S = ��,g n, t'ki Al o a" i ; Nk.r
Directions to site
Will timber be cut and sold in parcel preparation? (Yes/No)
Is-yotw...property within 200' of the following: Body of Water (( ame) I- kr,� I A�,L- Saltwater
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 a e E �� ,j��- =.b a L. „twai_ ='
No. of Bedrooms i s
No. of Bathroom _SQUARE FOOTAGE-1st Floors 2nd Floor
3rd Floor Loft Basement _ Deck Other sq. ft.
Garage Attached - Detached Carport Attached Detached..,---
MOBILE HOME INFORMA 16N-Make Model Model Year
Length h � Serial No. Ncr"of Bedrooms No. of Bathrooms
Type of Heat ., ' �Purchase Price $ .,� Replacement Unit ?(Yes/No)
Installer Name ' r E;ertification 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-1 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 chariges shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without
approval. ,_„ -.._ 4� first obtaining approval.
X � d�� ,- ;rtA�Date j"' � V X '` Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by$ 0- � +
_
Date 1 ' 4mittal Amount Due 7 ,�=1.I eceipt No. 1
�aT _
v
DEPARTMENTAI» REVIEW APPRL?VED btNIED CQNDITI+DN COPES
Building Department 30'OCA
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $LALAX(p
FEES
Building Permit Fee
1 OL Site Inspection
Plan Review Fee ul EH Review Fee
Plumbing&Base Fee A -OO 00 Planning Review Fee
Mechanical&Base Fee ��'�b Other
50
Wood/Gas/Pellet Stove Fee State Fee
L
Violation Fee Pre-Paid at Submittal
TOTAL FEES
FORM MUST BE COMPLETED IN INK PERMIT NO.:
PLEASE PRESS HARD MASON COUNTY
PLUMBING/MECHANICAL 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 IN RMATION
Owner M A2K 5t0"1E5Zf2�i,E I' Contractor Name
Mailirt Address Callt FbAO 19AV'f Mailing Address
city 19��tR&P- State \N/ Zip Code 6i`h3 3 Sr City to Zip Code
Phone 25 Aj-,.W` Other Ph.(2S3 ) `1�3-��537 Ph.(_� Oth Ph.L�
Lien/Title Holder Contractor Re
#
Address Expiration
SEPTIC INFORMATION-Connect to New Septic xisting Septic_ Connect to Sewer System Name of
Sewer System
PARCEL INFORMATION-12 digit Tax Parcel No. 223-;p5'00,00 /I t Fire District
Legal Description G,,f 31 H#IIGnjty'
Site Address(Please include street name, street number and city) 2v2i q g AA lEw/ 4-Ag-E-
Directions to site Fu l lv�s �CHI f}A Gov L,4i� Lo/- s oni N. sit Cx= L/+KG
Is your property within 200' of the following: Body of Water(Name) 1 AviN LA 57 Saltwater
Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use of Building
Location of Fixtures/Units 1st Floor 2nd Floor Basement Garage Closet
PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric
Type of Fixture No. of Fixtures Fees LPG Natural Gas Heatpump
Toilets I Type of Unit No. of Units Fees
Bath Basins Furnace
Bath Tubs 1 Heatpumps
Showers Vent Fans
Water Heater 1 Propane Tank
Laundry Wsher I Gas Outlets
Sinks �_ Wood/Gas/Pellet Stove
Dishwasher 1 Direct Vent?
Other Other
Other Other
Base Fee Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL 8�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 AF VIT-I certify that I am cu tly registered as a
Contractor Registration Law RCW 1t3.27 and am aware of the ordinance contractor in the State o ashinfor and tha aware of the ordinance
requirements for which this permit is issued and that all work will be done in requirements regulating the rk for whi is permit is issued and all work
conformance t rewith. No ange shall be made without first obtaining shall be done in conformance t e No changes shall be made without
approval. first obtaining approval.
X° Date /- J 0 X Date
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
FEE'i##iTMEiVT R1;V#E1tk
RP�RL7Vrwti DENIE]}_:. :: GQftfFlF1 IS?N CF?E5
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
..... ::::::.:..................................
Permit Fee Site Inspection
Plan Review Fee EE± UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal )
Violation Fee TOTAL FEES
MASON COUNTY PROJECT SITE INFORMATION
Case No.
Name r �, { 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 SetbacksShorelines
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 lined I I <-adjacent property line
1
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adjacent property line- I ' Fad'acent ro ert line
SAMPLE SITE PLAN
adja t property line-> rafsaRE — I E-ddjacent property line
D 30 v _.�3o-
I a L TSL_ )
CREEK AL-� HOM t i Gaatu
I > PROP'= saps:c I
1
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VAGn,T c.ArtAccs
� 30' T 1 i
I� C0.oPosCD I AbR=[J-LTWLAL 50
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adjacent ro ert line-� E-adjacent 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
dts+�r.cm fin
Srf ruttt,�Y�
d;��'ar,cG to
51opa f-e¢
dis+anc�
to t
Date
Signature
FORM MUST BE COMPLETED IN INK
PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION
Case No.
q�
Name / ��isi2K 5+a-4esA( e f _PARCEL NUMBER `Z2 3 305-0000 3/ Date i24Z_7 0
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-J L
DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line.
adjacent property line4 I I Fadjacent property line
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adjacent property line-)- I I E-adjacent property line
SAMPLE SITE PLAN
adja t property lined 3iO� rRR�RvE _ _ I E-adjacent property line
3°' 30�
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adjacent property line-� E-adjacent 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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ru.ctL.a.Ye_
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Signature Date