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HomeMy WebLinkAboutBLD99-0659 SFR - BLD Application - 7/20/1999 PERMIT NO.: BLD ! &7,0 W MASON COUNTY 7 BUILDING PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275- 46 Elma 360 482-5269 Seattle 206 464-6968 AFPLICA T 1NF RMATIO CONTRACTOR INFORMATION Owner Contractor Name Mailin Address Mailing Address City State 4� , Zip Code WSJ City State Zip Code Phone( 3Ac, Other Ph.( 46- Ph.( ) Other Ph.C � Lien/Title Holder /I?A.y C Contractor Reg. # PAX 4 0$ 1101FAI !7 Address 3 Expiration i' SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic _Existing Septic Connect to Sewer I' System Nam�Qf Sewer System Well Water System _Name of i Water System I-wg400,,-' .�• 30 - IA - cf000 li PARCEL INFORMATION-12 digit Tax Parcel No. / Fire District ii i Legal Description Y-g -owl aF gsfrs Site Address(Please includ street na street nu e nd city) ,fir. got,r>r!C f Directions to site Grri e ft All'wdo Y719 r i Will timber be cut and sold in parcel preparati f Is your property within 200' of the following: Qody of Water(Name) SaltwaterN Lake River/Creek Pond % Wetland Seasonal Runoff 'Stream Slopes or Bluffs i 4 F > TYPE OF JOB New Add Alt Repair Other Use of Building t..r! Describe Work w-- a No. of Bedrooms_ No. of BathroomsA�SQUARE);;OOTAG€• 1st Floor /0011' 2nd Floor ' 4 f� 3rd Floor Loft Basement Deck/6A gD Other sq. ft. Garage f ,t-Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make_ Model' Model Year Length Width Serial No.f No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. f NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OF CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHINy180 DAYS OR IF. y CONSTRUCTION WORK IS SUSPENDED OR ABANDgNED�&*PE IOD OF 180 DAYS AT ANYTIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A P 6GRES4 INSPECTION. The owner or agent on owner's behalf,represents-that the. information provided is accurate and grants employees df Mason Couhty access to the ab'bve described property and structures for review and f inspection of this project. Acknowledgment of such is by signature below: � r OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I 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 j am aware of the ordinance requirements for which this permit is `�led and that all work will be done in requirements regulating the work for which this permit is issued and all work I. conformance it No a esIshall be made without first obtaining shall be done in conformance therewith. No changes shall be made without appro first obtainin approval. + . X r . Date X , Dale_ Dn FOR OFFICIAL USE BEYOND THIS POINT(' �S Accepted by ilvl", Date Submittal Amount Due jJ Receipt No. v Y DEPART... 111T RIW Af'PRQVED DNII~D' C(3NDIT1C1 CCp;�S Building Department Occ Group V T e Constr. Planning Department Environmental Health Department Public Works Department 1 Fire Marshal 0 X R3 88�1!571� d wrowr`1 oT� " Valu ion $ 80J, n-ta✓,r. Building Permit Fee 8 a,5) Site Inspection P an v'ew F e UFC Plan Review Fee Plum bin fee16q Public Works Review Fee Mechaniclil Base e .� Other Wood/Gas/Pellet Stove Fee .� Other Violation Fee Pre-Paid at Submittal ( L11 a-8) TOTAL FEES ............... ........«..�.r..«.«... PERMIT NO.: PLEASE.PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 480 W.CedarJP.O.Box 100,Shelton,WA 88684 Shelton 1360XV411170 Belfalr 60 Z76-4467 Bhra 60 .6Z68 Seattle 06 64.6868 APPLICANTINFORMATI CONTRACTOR INF MAT ON Owner Contractor Name t' ut 4,&5 _lvc. Mailing Add ss 0, 7- Mailin Address city, State sttate, , Zip Code City Fu% StatetIrL Zip Code� Phone( e,),gyo[,Other Ph.( Fd, - Ph. ��Other Ph. d o Lien/Titie Holders©'ra-e-- Contractor Ree—eA—&A1Z d 1 e 1 M- Address Expiration / SEPTIC INFORMATION-Connect to New Septic Existing Septic,_,_Conneot to Sewer System_Name of Sewer System 7Directionstosfte ORMA ION-12 digit Tax Parcel No. Fire District ption X- 7 5 (Please Include street name,street number and city) r11. �. d e �T Is your property within 200'of the following: Body of Water(Name) Nd Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs TYPE OF JOB Newer,Add Alt Repair Other Use of Building c�_ 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 N�fFi�ides LPG X Natural Gas_Heatpump Toilets Tv of Unit No of Units Fees Bath Basins -S _T Furnace Bath Tubs AL Furnace ,T�Tss Showers Vent Fans ~Z 60� Water Heater , I Propane Tank 9.$- Laundry Wsher�_ Gas Outlets -- , Sinks �� .isv- Wood/Gas/Pellet Stove_ ,1 Otheras — Oa Direct Vent?—_ _ 7 Other Other � Other Base Fee Base Fee TOTAL PLUMBING TOTAL MECHANICAL 3 A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT. 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 AFFIDAVIT4 certify that I am currently registered as a Contractor Registration Law RCW 1827 and am more 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. Data FOR OFFICIAL USE BEYOND THIS POINT ,Yepted y Date Submittal Amount Due Receipt No, Building Department Occ Group Type Constr. Planning Department Other Other ti ;:.} IM . s •. Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing 3 Base Fee Other Mechanical 3 Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal Violation Fee TOTAL FEES FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION I azo(p - t a_ekmiCase No. / Name �al `5� �GL� `d'e�5 �'��� PARCEL NUMBER Date L 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 1111 DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or within 100 feet of adjacent property line. adjacent property line4 , , adjacent property line I I 140 � I I yvuV�s � I I I C I I � I I I � I I � 100J ► , J � I I I , b I , I adjacent property line4 ' I E-adjacent property line SAMPLE SITE PLAN adjar�nt property lined 3zo� Fadjacent property line 17 30' r v_ 3�1 SEAS,z%J AL. I P fi ,L CREEK I c I Mona a I ]I � HOctsG. I j Pao P D sa pt:c -�, 1 60' I VAGn,T c*Artwaa I �% VAoPmCD' \ \ I A&RzAu-LTWD.AL So' T — I I I , I ` I /00' I i L—e-LL I i x� /00' adjacent property line-� ; . �c �; <-adjacent pro pert'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 dlstanca. to naci-t�r� dcsta►',u. to ISlopm �-n¢ i ture Date MASON COUNTY PROJECT SITE INFORMATION —11 00, Case No Name :� ,t '„f;� 1 �' ..: � 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 t as DRAW SITE PLAN BELOW Include adjacent properties if on shoreline drwithin 100 feet of adjacent property line. adjannt property lined 1 1 <-adjacent property line 1 1 1 I I 1 : I I 1 e�A. I I I I � 1 1 I { : 1 «.. .erg•"""" I 1 I I I I r 1 1 1 1 I 1 I 3 I adjacent property line-> I I <—adjacent property line SAMPLE SITE PLAN adja�nt property lined 3io' Fadjacent property line 1 17 36' rf1ESC_itvoj 30�i CREEK 1 c fi Hone e j I P .C�aatu I HOL.bQ I ) PrLoPauD s:ptia I f� 60• VACAkiT anRwa6 3e 1 I PAofmCO �k \ T A&RZAL"TWRAL 50 i I I 80, I , 1 � I I /DO' I 1 I I L" e-LL I 1 I a.itLL 1 adjacent property lined ; c <—adjacent properiV 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 dtst�.,u. to ruL1'4.rL dist'ar+ex- Date -Signature i 1 y } ; I i I 1 GARY YANDO,DIRECTOR STgtFO s U _ DEPARTMENT OF COMMUNITY DEVELOPMENT r 0 T z PLANNING --SOLID WASTE-UTILITIES N Y ° BLDG. I . 411 N. FH ST. • P.O. BOX 578 1864 SHELTON,WA 98584 • (360)427-9670 August 18, 1999 MEMORANDUM- FROM: Allan Borden, Senior Planner RE: BLD99-0659 Lyle Nelson, owner of Paradise Builders, called me by telephone to state that the home proposed under this permit is his own home, to. be.-used for his family. He is selling his home on south shore intending to occupy this residence. He was told by persons in the Permit Assistance Center to put Paradise Builders in applicant info box as well as the contractor info box, after he described to them that he would be residing in the proposed home. i i Recycled MASON COUNTY DEPARTMENT OF HEALTH SERVICES Date—IL-2 PO BOX 1666 SHELTON,WA 98584 SHELTON (360)427-9670 FAX (360)427-7798 ELMA (360)482-5269 BELFAIR (360)275-4467 �q kfe i f'd Grr -�,cX. SEATTLE (206)464-6968 PO lac x ( 2-i,P 13.c l&le.. L4 9Fs21P BLD Q 9-64-s-y Parcel Number 1 Z304 -- ! Z-90og Your building permit cannot be issued by Mason County Environmental Health until the following are completed and turned in: LaL Application of Water Adequacy. Approved septic system records or approved septic design for 3 bedrooms ❑ Complete and accurate scaled plot plan which shows all building(actual & proposed), driveways, location of septic system, location of reserve drainfield and wells. ❑ Report within the lastthree years from either a septic tank pumper or an Operation and Maintenance Specialist. ❑ Well Log. ❑ Water bacteriological analysis. Copy of a recorded Certificate of Residential Use for bedrooms.(sign ❑ and notarize the enclosed form. Either return the form to this office with a check for$8.00 payable to the Mason County Auditor or record it yourself at the Mason County Auditor's office and bring us a copy.) Other: If you have any questions, please call me at 360-427-9670 Ext 353. Cindy Bingham Environmental Health Technician