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HomeMy WebLinkAboutBLD95-1721 Final SFR, Deck and Garage SHORELINE PRE-INSPECTION APP - BLD Permit / Conditions - 9/3/1996 2 .~ir 'r Cle Oft ems•,. O C W w e" 1st 90 GO 04 x '�! -1 — U C -•E 4 -•1 n Q w � rF w ... nn -I -w > M ? Co3wS — .wm = w $ A -4: C} -1Cr- 7G err sos -* 31. w, -i � 7c rei r t r` easi ref � a is b c m c mmi taw l .c a""rt -'+� C7 D G9 �7 !Y► t •• . ••i 7t 0 . 'Q . G4 P" > Q C�.► r S.i p rn ... ... . ; -3 C -rf "ft 0 0 -4 Z N N Q •+ cm air m f m $ ce 2 i 0 O t'! xi C r" ZI Zl G4 { „"„ '--.ems � .fir «s fl . t t 2 •-1 # Q C G'? $ '"� „` {r w r w w ... l riR !e► ees w x w i f •w +Q �! '1f b "e '.� .�g w 1 arerwar ewa ,,a wp ff hi ,.r 4D J► f ]s . . . . . Z CR f- 1 % & O N * t M s a w w w � O� • weir• A # w f� ! 1 w w w 4 •r? ++i !M .'�I .'�t"P�?♦ -6 -6 -i t N +psaseer -a rw r3 rF f# 0+ 1+ f rR rl via errr as in Iso V 4D OR �a�cte e. s y► Oa► rt � lQ � S �► to w w '@ � b tAto r 'i #"!@ +++ae, ae t — SG� C -- wtC? •�1 •1 -•i � 5,Q? L"7p �w" I0 . 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Box 186, Shelton,WA 98584 427-9670/1-800-562-5628� PLEASE PRINT #1 Owner) 4f PP-y 57< lelc. Phone# "' Address d r Fire District# ity_,,_ice pn,e te&=? 2eW St zip Directions to Job Site Owner Mailing Address �eq. City -'e"�?` �rC'k C� St Zip Lien/Title Holder Address City St Zip #2 Contractor Name ® ��� .-elmP �� l4 �'- Contractor Reg#4"VaN Address e"e. f�� Expiration Date_/_ Z— �C City Nt �l 1c St 1Q3 Phone#� ,S'3 � #3 If septic is located on project site, include records. Connect to Septic?_,�t" Public Water Supply_Well Connect to Sewer System? Name of System j(Ifes' ential, proof of potable water is required) #4eel No. Z © ,�- al Description 4o� %� �� � P :n6:- � P ��'�` S #5 Building Square Footage: (existing/proposed) r 1st FI l/z od 2nd FI / 3nj Basement / Deck / #bedrooms / _#bathrooms / Z Garage / a Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building Z•s.,Ze-.r7 Describe work r #7 Type of Job: New _Add Alt Repair h m iD U ' #8 MOBILE/MA FACTURED HOME INFORMATION D 4 Model, a Make Model DEC 08 W Leng Width Serial No. #Bedrooms #Bathrooms Type of Heat ---HEALTH SERVICES Purchase Price$ #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: River Pond Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. k Toilets CIRCLE FUEL TYPE: G� Electric, A Bath Basins Heatpump, Other �J Bath Tubs No. Uak Fees ( Showers _ Furn BTU Hot Water Htr — Heatpumps f Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No.. Boilers/Compressors _Laundry Basins _ HP Dishwasher No. Air Handling Units _Disposal 'f cfm# 5-0 _Urinals Imo,, Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ . Other Gas Outlets _ Wood, Gas, Pellet Stove S 4 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COM- MENCED WITHIN 180 DAYS OR IF CONSTRUCTION OR Permit Basic Fee 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD TOTAL MECHANICAL $ OF 180 DAYS AT ANY TIME AFTER WORK IS COM- MENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE CONTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND AM AWARE OF THE MASON COUNTY AM AWARE OFTHE ORDINANCE REQUIREMENTS REGU- ORDINANCE REQUIREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE l CONFORMANCE THEREWITH.NO CHANGES SHALL BE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT FIRST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEPARTMENT. DEPARTMENT. i X OWNER Cie X BY DATE /2 — ^ 1r'S' DA E MEOW= I�Jate DEPARTMENTAL REVIEW FOR OFFICE USE ONLY F ved Cond. Hold Approval Planning: Environmental Health: Building Plan Review w Occupancy Group:_ Type of ConstL V'\ Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check oy Plumbing Fee Mechanical Fee --# 'D7 Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other# ,tiv Other TOTAL FEE [Building Valuation: 1�u1JV1V VV V 1V 1 1 1_0 1 L11t 11YA1i14 1 "A: •11.:[1.1�1 it POST OFFICE BOX 1666 SHELTON, WA 98584 (206) 427-9670 FAX 427-8425 APPLICATION* FOR DETERMINATION OF ADEQUACY Revised 09/01/92 INSTRUCTIONS 1. Complete Part I. No determination can be made until Part 1 is fully completed. 2. Complete only the portion of Part 2 applying to the type of water system utilized. 3. Submit completed application, with attachments to the health department for review. PART 1: APPLICANTRARCEL IDENTIFICATION ..... -iz:zz-• ...::::x: i•:• x:x x££sz:zxs:ixazx£x£IzIsx:s#Iii#IFiIL#ItIIIltiiii{€iliilii I£li six =sxii / DATE NAME OF APPLICANT �i4�d MAILING ADDRESS. �© /!� y� TELEPHONE -1-7 1 City 9 tat Zip vo o i LP ASSESSOR'S PARCEL NUMBER 17 3 evS SZ -y— Lo-�- SUBDIVISION (If Applicable) 4� ����' /�"�"Q'c '� LOT TYPE OF WATER SYSTEM (Check One) REASON FOR APPLICATION (Check one) El Public/Community Water System �t Building Permit, Single Family Res in Individual System, Drilled well Building Permit, commercial Individual System, Dug Well EJ Building Permit, Replace/Remodel Individual System, Spring El Land Use Application Name Individual System, Surface Water Type Individual System, Other Other PART 2-A: PUBLIC WATER SYSTEM IIIIIII##IIIII#II IIII#III#IIII IIIII###III#II#II####II#I###III##II#I#I#IIIIIII#III#II##IIIIIIIIIII###III#I#I#I#!II#II######!##!####III###I##U#!#!####################IIII##Ili NAME OF WATER SYSTEM T► G E R AXE WFI ID The water purveyor for this system has previously filed a certificate of water adequacy with the health district. 3 service I an manager of the above referenced water system. The water system has DOH approval for �_ water connections, with connections presently in use. The applicant has approval to connect to this 1s consistent with b system system. service of water to the applicant for domestic purposes both the water plan and the water right permit presently in effect. water lines are available to the applicant's property arrangements line, or the applicant has made satisfactorynts to extend the lines_ DATE SIGNATURE OF SYSTEM MANAGER MASON COUNTY SHORELINE PRE-INSPECTION APPLICATION PLEASE PRINT $70.00 Fee Required • SQ /14.. 1. Owner: ,1�Yr1/11 S 4 flhyz! ,14 Applicant: Site Address: Applicant Address: _ Owne ddre s: City: St—_Zip .§ City: I S+ ZiA._Zi. i I Phone: Phone: 3` 2. Parcel No - - Legal Description: A tract of land in Government Lot 6, Section 5, Township 23 North, Range 1 West, W.M. , in Mason County, Washington, particularly described as follows: COMMENCING at a point 30 feet North 850 34' West of the center of Section 5, Township 23 North, Range 1 West, W.M. ; thence South 10 35' 3111 West a distance of 450 feet to the TRUE POINT OF BEGINNING of this description; thence South 10 35, 31" West 100 feet; thence North 850 34' West about 200 feet to the East shore of Tiger Lake; thence Northerly along the East shore of said Tiger Lake, about 100 feet to a point on the lake shore about 200 feet North 850 34' West of the TRUE POINT OF BEGINNING, s a aw 4. Use of Building: 5. Is there any type of water on or adjacent to property?: saltwater lake to river pond wetland seasonal runoff other stream seasonal creek yllerwl'-- /4 Directions to Site: rwr ! AA us T' S d s ir, tot)Awry <A) If the information is complete, then Mason County must disclaim any errors resulting from deficiencies in the original application. Pre-inspection reports remain valid only until develo ment changes occur in the vicinity which affect the lot evaluated in this inspection. Ate: Applicant Signature: _:.1 Date: I i Return application to: Department of Community Development,Planning Division P.O. Box 578 Shelton, WA 98584 (360) 427-9670 Please include a $70.00 check or money order payable to Mason County Treasurer FOR OFFICE USE ONLY: Accepted by: Date: Please illustrate below the proposed uilding site in relation to water & property lines: y � j v � ' M T , 51 taa Departmental view - (For Office Use -nly) Planning Department Findings: