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HomeMy WebLinkAboutBLD20297 Addition - BLD Permit / Conditions - 5/26/1987 BUILDING PERMIT-APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUECIf?:c2'26-w '! PERMIT �7 OWNER NAME MAILADDRESS CITY&STATE ZIP -TO HR.SO4 F, t4O Mho A, Q Q&&a s DIRECTIONS O JO.SITE �J 4b O m o *tkr ,r, ie-++ br,tAcm ® ;D kouaalJt © Lteo.v-PARCEL EGA LIA / NUMBER �`.7i+ ZI (30o D SCL CONTRACTOR NAME MAILADDRESS CITY S STATE LICENSE NO. ZIP PHONE FkKG04& 9Vp-P,5C0144T, 6.140 kcLA*jL Dr h LO&AL PA C1 %►2 g8 USE OF y ZL-844 BUILDING CLASS OF NEW ADDITION ALTERATION REPAIR MOVE REMOVE WORK r WORK BE roorr,, a k 6 room to eop-M" o f- 1"GS roc-ess, ov\g- exisimr, beAroonxLa t ( be 6 r BEDROOMS_ DECKS CARPORT NOTICE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, HEATING, VENTILATING OR AIR BATHROOMS TOTAL SQ.FT. 1� GARAGE CONDITIONING. NO.OF STORIES t ' 'BASEMENT ATTACHED — THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED 18 NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK M SUSPENDED OR TOTAL SO.FT. ' 'FI REOLACE DETACHED _ ABANDONED FOR A PERIOD OF 190 DAYS AT ANYTIME AFTER WORK 18 COMMENCED. PERMANENT `SHORELINE SEAdbNAL OWNERSA (DAVIT CONTRACTORS AFFIDAVIT I CERTIFY° AT I AM EXEMPT FROM THE REQUIREMENTS OF.THE CONTRACTORS I CERTIFY THAT I AM A CURRENTLY NEGIBTERED CONTRACTOR IN THE STATE OF REGWRA AW RCW'*M',ANIR AM AWARE OF THE MASON COUNTY ORDINANCE WASHINGTON AND I AM AWARE OF THE ORDBlANCE M04U AMEM 1yEQULATINO THE R TSB FORVwfigA.TH18 PERMIT IS ISSUED_ AND THAT ALL WORK DONE WILL BE WORK FOR WHICH THE PERMIT IS MGM AND ALL WORK DONE WILL BE IN IN MANCE TWER�INITH. NO CHANGES SMALL BE MADE WITHOUT FIRST CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING STAINI AIPPROVALFROM THE BUILDING DEPARTMENT. APPROVAL FROM THE BUILDING DEPARTMENT. X O ER DATE X BY c����B'� DATE 5,1547 FOR OFFICE USE 6 IDLY DEPARTMENT YES APPROVE NO DEPARTMENT Y� E� BUILDING VALUATION HEALTH PUBLIC WORKS FEE PLANNING FIRE BUILDING PERMIT /67�2. 5-0 D.O.T. BUILDING PLAN CHECK S1 do!a SPECIAL CONDITIONS BUILDING GROUP — PRE-INSPECTION SHORELINE WOODSTOVE PLUMBING MECHANICAL STATE BUILDING FEE STATE SURCHARGE APPLICATION ACCEPTED BY PLANS CHECK BY APPROVED FOR ISSUANCE PERMIT VALIDATION TOTAL BY CASH CK MO PLUMBING & MECHANICAL PERMIT APPLICATION MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. BOX 186 SHELTON, WASHINGTON 98584 426-5593 DATE ISSUED PERMIT NO. OWNER 9AXY ME MAILADDRESS C1TY&STAT ZIP PHONE -/ O 1"A -2 D DIRECTIONS TO JOB SITE t `. ,� Ti4Ke 04d Arecmni fIC cv d!v d1v n--Z Du sE' ow h LEGAL DESCR. z 3 z.Q 2 1 DO D Z 0 CONTRACTOR AME MAILADDRESS CITY&STATE LICENSE NO. ZIP PHONE '4056A/S M ,E �U/ Ll�a . d)n 857VI -fZ-� USE OF / BUILDING 3ko ePoorr! o u.6 I- oo n PLUMBVG FI TURES MECHANICAL FIXTURES NO. 2.00 PER FIXTURE OR TRAP FEE NO. TYPE OF FIXTURE FEE WATER CLOSETS p p FORCED-AlR/GRAVITY TYPE FURNACE 6.00 BASINS FLOOR/SUSPENDED FURNACE 6.00 BATH TUBS BOILER/COMPRESSOR 6.00 SHOWERS p REPAIR/ALTERATION 6.00 WATER HEATERS REFRIGERATION COMPRESSOR SYSTEM 6.00 AUTO.WASHER AIR HANDLING UNITS 7.50 SINKS 2 m O HEAT-PUMPS 6.00 FLOOR DRAINS EACH GAS PIPING SYS.2.00 PER OUTLET DRINKING FOUNTAINS VENT.FAN SYS.3.00 PER UNIT LAUNDRY TRAYS WOOD STOVES 5.00 CONNECT TO CITY SEWER WOOD FURNACE 5.00 DISH WASHER DISPOSAL URINALS PERMIT BASIC FEE 3.00 PERMIT BASIC FEE 10.00 TOTAL ,o o I TOTAL SPECIAL CONDITIONS: NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION D 7- (.c$ DA'I AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS,OR IF CONSTRUCTION OR WORK 16 SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. OWNERS AFFIDAVIT:I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF CONTRACTORS AFFIDAVIT: 1 CERTIFY THAT I AM A CURRENTLY REGISTERED THE CONTRACT OR REGISTRATION LAW ROW 18.27,AND AM AWARE OF THE MASON CONTRACTOR IN THE STATE OF WASHINGTON AND 1 AM AWARE OF THE ORDINANCE COUNTY ORDINANCE REQUIREMENTS FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES SMALL BE MADE WORK DONE WILL BE IN CONFORMANCE THEREWITH.NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. WITHOULMRST OBTAINING APPrOVAL FROM THE BUILDING DEPARTMENT. X OWNER DATE X BY DAT FOR OFFICE USE ONLY APPLICATION ACCEPTED BY PLANS CHECK BY BUILDING GROUP APPROVED FOR ISSUANCE PERMIT VALIDATION IBY CASH CK MO PLOT PLAN` ADDRESS F 140 MAMMA KJ, to F-,4/;e, WA PERMIT NO s � s o LEGAL _DESCRIPTION LOT • ELK ADDITION M SITE AREA Sq.Ft. AREA OF SITE QC CWIED BY BUILDINGS Sq.Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED VA*N PLOT PLANS DRAMlN;TO SCALE OF NOT LESS THAN i"-W' ARE FILEO-WITH PERMIT /PPLICATK1Ni. (EACH BUILDING SITE M IST HAVE A SEPARATE PLOT PLAN.) FOR NEW 841LOI iB PROVIDE THE INPOWATM IN THE S►AM SELOM l A.00ATION OF SIt1 IB D AMID Ex ""IR� ,s�lOw BUILDING.$17E.AND SEK bt111lEN- ' iN .<tIRST F OOR$LEVATION. ELE1/A- TION ANO ICE 1 ATIC1Ai;,. t ATi OP WA R, SEWER, a ANCIt ICAL BERVIt:E LINE:.SHOW LOCATION OF SURVEY Ne.SPECIFY THE USE OF EACH BUILDING ANb MAJOR MR- TION THEREOF. INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE S' X W OR 1"-20' a NJ . 1 I/Wa certify that tM propoasd oonat►uction will nontonn to the dinsrnaidna and uaaa shown above and that no dwnoa will be made without first obtaining approval. GAR.Y Johnson A tcc.o NAME 'OwN OF SITE a STRUC• URET ) 11P 1NTI '3115NATURErOF OWNURM OR AUTHOPRIZZO --. 00 NOT/YR[TE 1EtOW rpm L/NE APPROVED DISTRICT AS NOTED DATE fob NONE now" IR OWN ,■ ►. ■ ■■■I■■ ■ n, I i .rr I, � ONE U IMF NQ ■ AP : . 3 Id M !w 5 0 Shorel f*w .Setback: a111ca t Special r1or: Condi t ices: FAIL: eke 9etector: 0o ng: perks: Setback: Fowndati --- walli: Framing: Wood St�►r►e: lML DACE TYPE Mit No. .20297, " No. Floo � F ' dMs e a �� ntrocto'r a a Nye #: Zip *ess s�dte. D Legal Ike r � � p Di MUM to projec s e BR 1�ft aft r bred a onto c a E b Made n9 an Ca ewer F i►Basement a raige -' ' Basement Eck art ADD BEDROOM, OATH, HOT TUB ROQN, R.a ! \y APPLICANT NAME: 04— DATE: BUILDING PERMIT CHOMLIST SITE ADDRESS D If site address is not listed, customer needs to be given a site address form. MAR 1 4 1996 FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to;A aS ICEF DIRECTIONS TO JOB SITE Needs to be as complete as possible (i.e. major roads, is house on left or right side of road, etc.). Be sure to read for clarity (Landmarks, signage, owners name on mailbox, etc.?). uEN TITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? CONTRACTOR REGISTRATION #E AND EXPIRATION DATE This information needs to be provided. The Building Department may be able to research customer does not know it. We must have a signature in 1 of the 2 b Hanna or r t e000^ H boxes, either the applicant o the contractor. SEPTIC RECORDS 7 ►va W a A '�.v �e��L-;e WATER COMMUNITY PRIVATE SEPTIC EXISTING DESIGN APP. DEV REMODEL NEW STATUS PARCEL #F Parcel #r must be included or researched through Gateway. BUILDING SQUARE FOOTAGE Verify that boxes are filled In. If there is a garage, verify whether it Is attached or detached. Include square footage Information for mobile homes (you can multiply length X width to determine number). USE OF BUILDING Is it a resideAce, garage, greenhouse, etc. . .? DESCRIBE WORK P.O. mobile home addition, addition to a house, etc. . .) TYPE OF JOB Verify appropriate boxes are marked. ❑ MOBp.E HOME INFORMATION 'Verify appropriate boxes are marked. If factory order, please put factory order#t in mobile assembled prior to June 15, 1976, refer to procedures handout for "O home aerial#�. If unit was Assembled Prior to June 15, 1976." "Obtaining ea6on Permits for Mobiles ❑ SHORELINES 1�a tg� ( - 1'2�.C� al✓ o(ayl t✓ , It any water is on or adjacent to property within 200 feet, #9 must be complete. Once permit is entere Tidemark, It will be routed to the Planning Department, If property Is not on wow, t d into hen put "n t i � •n/a". 1 SITE PLAN DRAWING Must have setbacks from all property lines, easement lines and structures. Drainfields septic tank location, outbuildings, etc. . . TOPOGRAPHY DRAWING If property Is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing must reflect this. ❑ 'AUMBINGIMECkfANICAL This form must be completed for any structure with plumbing and mechanical excluding mobiles/modulars. OWNER OR CONTRACTOR AFFIDAVIT Owner a contractor must sign affidavit statement and date it. ACCEPTED BY Whoever is accepting permit information must sign your initials and date form on the bottom of page 3 or use date stamp and initial on back of permit. PRINTS Need two sets of prints unless it is a stock plan. For stock plans, we only require one copy. ❑ WATER ADEQUACY For new residences and mobiles. PRIVATE WELLS MUST HAVE WELL LOUTS OR CAPACITY TESTAW BACTERIAL ❑ h(/ TEST. If they are on a public water system, verify the water system is in compliance with State tequir nrents. MWSEC S V&IAO CODE ' l Required for all residential, additions and commercial buildings, Energy Code compliance form needs to be COMPLETED. Verify heat source(no wood or pellet stoves are permitted as primary eyatem), Window sciodl/e inin be filled out and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in a � Termong Super Good Cents program, we require a copy of the signed agreement with the unity. ❑ ROAD ACCESS PERMIT If you will be accessing your driveway from a County road, contact the Public Works Department In Mason Cotxvty f ding 1,427-9670 extension 450. Access from State Highways requires Department of Transportation approval. Contact office (206)895-4753 (Port Orchard). • ACCEPTED BY: -C •• DO NOT ACCEPT PEFAW APPLICATION WITHOUT PRINTS AND REQUIRED DETAILED INFORMATION (SETBACKS, ADDS, PARCEL. lie AND WATER). ct*cklst.bW 9/20/93 2