HomeMy WebLinkAboutBLD93-0056 Final Garage/Shop - BLD Permit / Conditions - 3/18/1993 Nu
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CONCRETE$fj ,,g y R ffk)e MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
dated-Y' by Gas Piping date by
Foundation Walls date by Set Up
date by INSULATION date by
SGISL.AB Insulation Floors Final
data by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NAILMO
date by date by
Water Line FINAL INSPECTION
date by date by date by
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CONCRETE MECHANICAL MOBILE HOME
Footings-Setmc k date by Ritibons
date by Gas piping date by
Foundation Wells date by Set Up
date by INSM ATION date by
BGISLAB Insulation Floors Final
date, by date by date by
FRAMING Wells FIRE DEFT.
date tv date by date by
F PLUMOMIG Attic OTHER
Groundwork
date by date by
D.W.V. WALLBOARD NALING
date by date by
Water line MAL INSPECTION
data by date 3—I g-,15 by date by
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Permit No.BLD _
NOON COaM
BUILDING PERMIT APPLICATION
PLUM PRINT
#1 Owner —phone# re7
Site Address .3
Cit t Zip
y
Directi + , ,T Si't&Ajya defd "&A-a, f-0JJ6 PIA.Le &34 ;J 42,j A
ei
Ira Pik—
vm
Owner Mailing Address A -
city St zip-
Lien/Title Holder
Address
City St Zip
#2 Contractor Name. 4Q 16= 6,"% Contractor Reg#
Address Expiration date
City St Zip Phone:
43 If septic is located gn project site, include r ords. Virg
Connect to Septic?_15 Public Water Supply_ Well
(If residential, proof of potable water may be required)
#4 Parcel No.
Legal Description IU
#5,� uilding Square Footage: {existiaq/vzwagem
ist Fl 2nd Fl / 3 rd Fi / Loft /
Basement / Deck / #bedrooms ,`
0 Garage Carport . / (Circler Attached or Detached?)
Other sq f t
#6 Use of building "J;:�Jjfpll Describe work
#7 Type of Job: New,_ Add Alt Repair Demolition_
Woodstove,4* „_ Re-Roof Bulkhead Other
#S MOBILE HOME INFORMATION
Model Year Make. Model
Length Width Serial No.
#Bedrooms #Bathrooms Type of Heat
#9 Any water on or ad' t operty: saltwater lake,_._
river pond tand,_, seasonal runoff
other
Show following on the site plan
i
Lot Dimensions Flood Zones
Existing Structures Fences
Structure Setbacks Driveways
Water Lines Shorelines
S'
Drainage Plan Topography .� �► c'46i.rj ;
Septic Syst � w � 1+1`s .' � =�;�";
Proposed �pt5 Easements w
Name oil Fl . g Street ' f r ' 3, ?`• :►
Name : Scale:
of. Street to•
Pt z g .
l TOk� + PL��.�. _ � ,. .
6
t
A fq
PnA
G i k
PLICAaT To DRAN TOPpGRApHy PROFIL> Y
yr
-Plumbing Fixtures ($2 each)
No. Toilets Went Systems X 3 .00
Bath Basins Vent Fans X 3.00
Bath Tubs No. Boilers/Compressors
Showers ,.,_ 0-3 HP 6.00
Hot Water Htr 3-15 HP 6.00_ .
Laundry Washer _ 15-3 0 HP __.6.04_
Sinks 30-50 HP 0
Floor Drains - 50 + HP 0
Laundry Basins No. Air SaAndling''IIait
Dishwasher <: 10000 cfm .50
Disposal > 10000 cfm. 7.50_
Urinals Other
Other Evap Coolers
Hoods
Permit Basic Fee 3 .00 Fire -Suppression
TOTAL PLZM=NG $ Domes. Incin.
Comml. Incin.
Reloc/Repair 6.00
Mec an"A 17iYturei Gas Outlets X 2.00
No. Fuel Types - Woodstove separate
F= < 100K BTU 6.00 Other
Furs >= 100K BTU
Floor Q_ Permit Basic Fee -1,O.QO-
Heat Pumps 6.Q0 TOTAL 8A1Q2CAL $`
NOTICS s =:.. TSIS PZVA=T B C'f 3L488 :%-AND VOID- III' WORK OR CONSTRt30"!*i
AMMOI IZED IS NOT IMNCBD .WITH1N ,180 DAYS, OR IF ojt f3A'?Et$
IS SUSPBNDBD OR ABANDON$D FOR` A PERIOD OF 180 DAYS AT Ar Y'r'IlKE AFTER WORK
IS COMLBNCED
01-1I S AFF=A►VIT COZ tAC ORS AFFII v=
I CERTIFY THAT I AN MM, FllDwl Alt T3 OF.THE I CERTIFY TWAT I AN A CUMP LT REDIETGRM,
3' : tiiMl Nil /AWIIZE IN THE STATE`I 11ANNINi M AM I AN NE
Of TIE NAM COIK'� AND MANX F0.40icN GROIIIAIICE R MIMMMn GM At.NS THE AWII-F OF THE
Co�NAcraN3 IuliISTNATION LAiI INL1i
•NO�IC -FOR WNIQN
THIS PERMIT IS ISSIIE0 00 TWAT ALL K OW WILL K IN TINT PERMIT IS' IMMAM AM ALL WORK OOINI WILL M IN
CgIfQINf M TNMWITN. , WOK
CNAN6EE'.SINLLL NE WE CONFOR Y NCt TMMMTN.. 110 CWJM "'.SNA1 L K WIDE
Wnmff FIRST csnmI= APPNWAL,,,,.FRINI. THE wlnDin WITNOIR FIRST OBTAINING APPIMAL FMM TNN WILDING
OEPARTNR�NT. OEIANTMENT.
$ own] I Z BY
DATs IDIATS
Return permit to: Department of General Services _. . .
426 W. Cedar/P.O. Boa 186, Shelton, WA 98584 427-9670/1-800-562-5628
FOR OFFICIAL IIS8 OIMY: Accepted by: —T' -Date:
-���3
DEPARTMENTAL REVIEW
FOR OFFIcs Um OILY
Appre"d Conti NOW
ApprWat
Planning: �
63
IF
Environmental Health: P�N se&,c Qetor6s '
Building Plan Review:
Occupancy Group
Fire Marshall:
Other:
IlSpecal Conditions: q gSite Inspection
q q
q q gBuilding permit
I � q
gViolation Fee I II
q 'I
N
q lViolation Iuvest .fit on Fee ( q
p q
Plan check
q u n
II q Plumbing Fee
II II gMechanical Fee
II
II (( IIWOodstove Fee I II
II q I
(( QBuilding State Fee I II
i ._
((Building v ,' r
• ' MASON COUNTY
DEPARTMENT OF HEALTH SERVICES
.inwronmentd Hea)di
►vas.Qud;ty
PO BOX 1666 SHELTON,WA 9&%4
LOCAL(360)90,7-9670
BELFAIR(360)275-4467&4468
Application for Determination of Adequacy TOLL FREE 1-800-562-5628
VAX(360)427-7798
Instru
1 : .>: ..... . . .... �{�;
PART 1: Applicant/Parcel Identification
Date
Name of Applicant-,J������
1.
Mailing Address Telephone D� 22 q-
Assessor's Parcel Number I 1
e o Water Check One : on or lication Check One
o Publie(Community Water System(2 or aura But7dmg P=rt
ooam iooa) o Land use application,if so..
W-/ Individual water source(ono 000nwfian),if so.. p Division of land
q/ Well #of Parcels?
o Springh urface water SPI39 -
o Other(explain) o Boundary line adjusirna t
0 other(explain)
PART 2: Water System Information
Complete the section appropriate for the type of water system being evaluated for adequacy:
Public Water System
Name of Water System
Water Facility Inventory(WFI)Number:
a The water purveyor has filed a letter granting blanket hookups to this water system
ed for services. There are
.
o I am the manages of this water system The water system has been a � s water.system is able and
moons muse.��=e�out ex the limits of the water system or any limits
Wifling p v�wates W Otis(these)
set by state and local regulation.
Signature of Water System Manager Date
H.•IWDATAURCWWWATEM3.WP Update:October 20,1995
w-7
R
Individual Water wen
o Water well report(attach to application) Depth -*2,6 fL
Well capacity test(attach to application) m
�Q—gP and
Well ccity tests are often performed by the well driller at the time the well is constructed. Test
results froapam these tests are noted on the water well report. Results from these tests will be accepted.
If the water well re off cannot be located by the applicant or if the water well report does not have a
capacity test~a well capacity test,which provides stabilization of draw-down and recovery data,must
be performed by a licensed contractor.
1/ Satisfactory bacteriological test(attach to application)
Individual S rin /Su .ace Water
o WDOE permit(attach to application)
o Method of disinfection
o I have reason to believe that this water source can provide at least 800 gallons per day and/or provides water
at a rate of 2 gallons per minute based on the following observations.
AUTHOR OF STATEMENT DATE
RELATIONSHIP TO APPLICANT
In addition to providing the above statement,the applicant will need to arrange an on site inspection by the
health department prior to determination of adequacy.
Departmental use only. Do not write below t6 line.. .
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H..IWD.4TAIARCH1MW.47ERAD3.WP Update:October20,1995