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HomeMy WebLinkAboutCOM2001-00030 Foundation Final - BLD Permit / Conditions - 7/20/2001 ' PERMIT NO.: BLD 3�29 MASON COUNTY COiY►1 ' BUILDING PERMIT APPLICATION e�cf 426 W.Cedar/P.O.Box 186,Shelton,WA 98684 <-e- Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 4 968 APPLICAW INFORMATION CONTRACTOR INFO,,RN TI 4 Owner Contractor Name �j Mailing A*b&ess 23Mailing Address t City State Zip Code City <X9 State, Zip Code Phone( �l.1) g�Other Ph.(� Ph. Other ( Lien/Title Holder Contractor Reg. # 4S H e4, t,�D3loe L., Address Expiration SEPTICIWATER 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 digit Tax Parcel No. t / / ^n n el Fire District Legal Description Try, a/ S Al 4:z- I-1 Site Address(Please include st•reqet nam street nu er d city) Directions to site U�C. kt1 ( -�'c7 M 1. / _11 t S - ,P I Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE Cl,,," SEASONAL RESIDENCE❑ TYPE OF JOB Ne -Add Alt Repair Other Use of Building Describe Work No. of Bedrooms No. of Efathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. j Garage Attached Detached Carport Attached Detached I MOBILE HOME INF'QR'ItAATION-Make t e Model Year Length Width Serial No. o. of Bedrooms No. of Bathrooms j Type of Heat Purchase Replac enf Unit ?(Yes/No) Installer Name ertifi cation 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: i f OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-[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,4onformance therewith. o changes shall be made without approval. first obtaining oval. _ I X Date —Date— FOR OFFICIAL USE BE THIS POINT Accepted by Date Submittal Amount Due Receipt No. ...:::.:. . . .....:. .:..: . : EPA RTMEN7' .R V E AP:PR0 E p�NIED »: Ot?NDITIO DES :,...A Building Department 3 3D__0 F Fou ry D A T S 0IV o AJ L-Y Occ Group Type Constr. Planning Department I Environmental Health Department I Public Works Department I Fire Marshal i I Valuation $ 0100Ma Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee I Mechanical&Base Fee Other I Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) r � TOTAL FEES PERMIT NO.: BLD MASON COUNTY BUILDING PERMIT PERMIT APPLICATION 426 W.Cedar/P.O.Box 186 Shelton WA 98584 " r ` " -� •i Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 4 96 68 �J APPLICAW INFORMATION CONTRACTOR INFO ,TI Owner 't_t`C_ (iL-4Contractor Name Mailing A ..,ress, 2 3 16 Mailing Address c? l rr City State Zip Code City ' State, Zip Code Phone( !�SY41 Other Ph.(� Ph. ./ Other Ph.( Lien/Title Holder Contractor Reg. # As I/- ,/t&.;-ID34 pLt Address Expiration SEPTICIWATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System Well Water System Name of Water System PAR ATION-12 digit Tax Parcel No. / / nn Fire District ' Le I D iption I Si d s(Pleas include str t am , street nu er d city) i Dir cti s to site I J,_ P`, - v i j Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or i Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE,pF JOB Ne -Add Alt Repair Other Use of Building s '` j Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached 'MOBILE HOME INFORMATION-Make del Model Year Length Width Serial No. '-No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price$ _Replacement Unit ?(Yes/No) 4 Installer Name Certification 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: i OWNER AFFIDAVIT-]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 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 donXin nformance therewith.,.No changes shall be made without approval. first obtainioval. X Date < Date FOR OFFICIAL USE BE THIS POINT fAccepted by Date Submittal Amount Due Receipt No. ..:......::......................:.:..::::..,.....:......:..,..:::::::::::::::.:. .........:.::..... . ....:.:..........:.. :.:::::. . :::. ::::..:...:.:...:...............:::..................................................... R?MEt�ITi :R V E- �kPPRQVEfl t NIED';: QfJI�iQFTI N Q 1DES:::': : .. ............... . ....... . ........ Building Department Occ Group Type Constr. Planning Department i Environmental Health Department Public Works Department Fire Marshal i Valuation$ i 3ZY..� TT Building Permit Fee Site Inspection kPlan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) � h$ TOTAL FEES .�`,... I PERMIT NO.: BLD MASON COUNTY 3" BUILDING PERMIT APPLICATION I- � - . f = 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 46+668 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ',. r =f, d 1 .t Contractor Name ;r-/ :tt,.-;. , Mailing Ad6ressT,' Mailing Address _ r;a_ City State Zip Code City r,. ;xis State i =- Zip Code,-, 1""' Phone( zg +_— Other Ph.( Ph.( Ph.( _" It:. ld e. y Lien/Title Holder 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 digit Tax Parcel No. z, / / f ; Fire District Legal Description ��i �zj Site Address(Please include str et nam street number a1 d city) Directions to site t ) %{ l � � f't'1 �f �i a hY 1": to a''�� Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs PERMANENT RESIDENCE Cl,,--'SEASONAL RESIDENCE❑ TYPE4,©F JOB Ne Add Alt Repair Other Use of Building t Describe Work —/— = No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. ' No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification 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-I certify that I am exempt from the requirements of the CONTRACTOR'S AFFIDAVIT-I certify that I am currently registered as a pContractor 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. f I t r }' X Date >"r r" t��� � '�{ Date FOR OFFICIAL USE BEYOND`THIS POINT Accepted by Date Submittal Amount Due Receipt No. .............................................................................................................-...................................................................................-..........-.................................................................................. ..... .... :I� PPXR::aVt N :RIwV APPROVED[i DENIED Cr~NDITI N;:CG t . _.. _.. ..... ........ ..... ......... _ ........... _ _ _. Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department Fire Marshal Valuation $ E Building Permit Fee Site Inspection Plan Review Fee EH Review Fee Plumbing&Base Fee Planning Review Fee Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee State Fee Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES FORM MUST BE COMPLETED IN INK , PLEASE PRESS HARD MASON 'COUNTY PROJECT SITE INFORMATION Case No. Name PARCEL NUMBER " ' /_ aaD.Ze) Date S SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences N 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 E-adjacent property line I� �S u4rvE I I I � LAD66 I 600-F---�)+ I I vl oo \I � I �/.I Ifs' I N �� I FiELD 3; q00�- I I I I I I I I I I adjacent property line- I I Fadjacent property line S EE S cJ PFU�M Z7-/V"T-7-\-L SAMPLE SITE PLAN adjar�nt property lined Fadjacent property line I v 30' rii sc-w 3�1 SE .i AL I a _�'PT7L__,� F`RcF{G '• \ A fi MOM t I \ \ J. Cs q-- y I Houses I If— bn' I I VAGt.,T c.ArtA— iM1.?.,a \ 'I A"=LLLTuJLAL SG I I I , I � I /00' I 1 �C c..�LL I 1 I I I t.r�e I adjacent property line-) 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.) 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