HomeMy WebLinkAboutMIS93-0249 Cancelled Pier, Ramp, Float and Piling - MIS Application - 10/22/1997 L1 _ Permit No.
MASON COUNTY
J = 0 8 699.E BUILDING PERMIT APPLICATION '
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 ��
PLEASE PRINT
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#1 Owner Barbara Rozgay Phone# ( 206) 898-2768
Site Address E. 10071 Highway 106 Fire District# 6
City Union St Wa. Zip 98592
Directions to Job Site Project is located at E. 10071 Hwy . 106 near Union.
Owner Mailing Address 2038 79th Ave . N. E.
City Bellevue St Wa. Zip 98004
Lien/Title Holder None
Address
Clty St Zip
#2 Contractor Name Undecided at this time . Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records. N/A
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#4 Parcel No. 32236 _ 51 _ 00019
Legal Description Trs . 19-21 & T.L. ' s Pebble Beach Park.
#5 Building Square Footage: (existing/proposed)
1 st Ff / 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other Pier , ramp , float & sq.ft. 811 /
Piling
#6 Use of building Private moorage and recreation. Describe work Project
Consists of driving 9 pressure treated piling , constructing a 6 'X40 '
Pier , a 20 'X30 ' Float w/boat slip and a 4 'X40 ' aluminum ramp as per plans .
#7 Type of Job: New XX Add Alt Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No.
#Bedrooms # Bathrooms Type of Heat
Purchase Price $
#9 Indicate by circling the applicable source if any water is on d'acent to subject property:
,,,,
River Pond Creek Stream Wetland Lake Marsh 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 Indicate Directional by (N, S, E, W)
Name of Flanking Street in relation to plot plan
Name of Fronting Street
APPLICANT TO DRAW SITE PLAN BELOW
SEE ATTACHED PLANS
APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
SEE ATTACHED PLANS
Plumbing Fixtures ($8 eagM Fee Mechanical Fixtures ( 6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. U= Fees
_Showers _ Furn BTU
_Hot Water Htr — Heatpumps
_Laundry Washer — Vent Systems
^Sinks — Spot Vent Fans
_Floor Drains No. Boilers/Compressors
_Laundry Basins HP
Dishwasher No. Air Handling Units
_Disposal cfm#
_Urinals No. 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 $ No.. Other
Gas Outlets
Wood, Gas, Pellet Stove
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
OF 180 DAYS AT ANY TIME AFTER WORK IS COM- TOTAL MECHANICAL $
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
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.
X OWNER 0614y X BY
DATE Z 3 DATE
FAR OFFiCIALUSE ONLY Acoepterf by Otte:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
Planning: - �—�
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Environmental Health: i
Building Plan Review
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Occupancy Group: Type of Const:
Fire Marshal:
Other:
FEES
Special Conditions:
Building Permit
Plan Check G —
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: c t ` J TOTAL FEE a.�j
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