HomeMy WebLinkAboutBLD94-1788 MIS94-1004 - COM Application - 12/5/1994 Permit No.
MASON COUN Y
CANJ:J�i BUILDING PERMIT APPLICATION
/� 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT \J
#1 Own � A• Ct� _ Phone#� '�� Z75 - 3Db
Address_ Fire District# SA
City f--�A(A— St c.v4k Zip `f&. 4'6
Directions to Job Site We st erl Z 3ao
Owner Mailing Address tkw 3(TC)
City 'C>UL At St c,ar14 Zip 98j2$
Lien/Title Holder
Address
Clty St Zip
#2 Contractor Name (Z,�,Y-72 L r2 Contractor Reg#
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? Public Water Supply Well
Connect to Sewer System? Name of System
(If residential, proof of potable water is required)
#40 el N
egal Description 5E y¢ o
#5 Building Square Footage: (e*ls+�/proposed)
1st FI / ¢Soo 2nd FI / 3rd FI / Loft /
Basement / Deck / #bedrooms / #bathrooms /
Garage / Carport / (Circle:Attached or Detached?)
Other sq. ft. /
#6 Use of building �� �T" E:7 3D X /5L n" tDescriikelwork
pou4 G'o cl c ee .SctwS — C'o o 5T9--1-T Iq CT4L- Ltf L.0>
#7 Type of Job: New Add Alt Repair Other
�P' H (
#8 MOBILE/MANUFACTURED HOME INFORMATION 1J �
Model Year Make Model �-+
Length Width Serial No. PI E C 0 5 94
# Bedrooms # Bathrooms Type of Heat
Purchase Price $
HEALTH SERVICES
#9 Indicate by circlin the applicab if any water is on or adjacent to subject property:
reek River Pon C Strea 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. Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
Bath Tubs No. Unk 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 'x 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 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 OF THE 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 OWNE X BY
DATE DATE
FOR OFFICIAL USE ONLY:Aceeptetl by: Date: ,�'��-
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold
Approval
I
Planning:
;(7(
Environmental Health:
Building Plan Review _
Occupancy Group:1; -2-- Type of Const, —od
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit
Plan Check 2 7 (v
Plumbing Fee
Mechanical Fee
Wood/Gas/Pellet Stove
Radon Monitor
Violation Fee
Site Inspection
Building State Fee
Other
Other
Building Valuation: �S TOTAL FEE C)
BUILDING PERMIT # � , (4 / C�U4-
DATE I-L/-]
Planner Area
CHECKLIST FOR PROPOSED CONSTRUCTION
Yes No
[ ] [ ] Within 200 FT of designated shoreline, wetland, or
associated wetland
Where?
[ ] [ ] Proposed construction on/over/in wetland
( ] [ ] Proposed construction within floodplain
[ ] Eagle nest
State road access needed
[ ] Commercial Development (parking standards, sign
ordinance, public works review, other applicable
agencies)
[ ] [ ] Mobile Home or RV Park
[ ] [ ] Exempt from building permit application
[ ] [ ] Exempt from SEPA process (WAC 197-11-305, WAC 197-11-800)
[ ] { ] Meets all requirements (which section(s) of SMP does
proposed construction pertain to?)
[ ] [ ] Variance or Conditional Use Permit required
[ ] [ ] Exempt from Shoreline Substantial Development Permit
process (Wac 173-14-040)
[ ] [ ] Exempt from Substantial Development, but within Army
Corp. jurisdiction (WAC 173-14-115)
[ ] [ ] Address needed
[ ] [ ] Directions needed
Allan
/_i�la C�astPe l
275-
27s — 9957 hm
b ��titu�� Cur assx�
V
� ,a
ctff
C � A/75
ke ��
1174�
��X�71 f � GWZ4
d
dO lj(�L4�a 1176�
ri' y 4,
Pa) A
s
/� maul
a"p-, 7t
THIS PARCEL
INCLUDES
PLANS, BLUEPRINTS
O. R . OVERSIZE
IMAGES: ,
LARGE FORMAT
IMAGES HAVE BEEN, STORED IN
FILE CABINETS) UNDER
-- - PARGEL N�iMBER
PARCEL #�
CASE # �C
- = m > (n
0CDw w '" mw0omm -3 .-
DrnDpD2 - - m71r.D
> 0 f - -4 St00 > 0 > JS Tn '7 !) v > -4 > Jr
ce CD �., -; � 7: mr I rmm z0 -arcmCRrrr� x `
CA C) cniQ `!� r - -47z mr- -a V 0) rA ,^rO +
o a as ads ZD D "M — i z N r 00 0 . 0 • 0 m i7 :J -J
� S . ZZN ! m r --1C 'R '+1G' 0 -•1zm •
y. o : .• V zr , in 171 DOrnT!) m
i :� -• Qc� � C rStSG�
: t r 0 0 z C m 0 D
rs i m m
i s �a to m n
_ rn � � N r-
In .L
me-s o m G 9 5 N
> L7 W
at ms -
1 T a ++ A z� GQl7t' O "'Z7� i7 � nfAJJ •� 1) 'a '.9; 'TS � :•' Cr �i rim
T , `•'�'P� s» — D � - _ r- �• S � ao S > o — +- gym M -4 - 9
� r / s -..a c e•e f/J - � f!3 C - C -I fl �l O -� -i - Q � '.7 � Q J G i]t f•' a1
� N �zzSzza :� -am � 22 r xr7< orr � � � cr i r9
m - J1V - _ ,. ;� � W l9
> � - m rn .1 Co r Z -i 1- r!
j r (li - W -< ZL7ZCR = USGDf� ••- ;�7 09ztlJ
t- m fJ2 L737 m - 00 - z < C? m C) M
o •a m --i > to x D - 0 - rn rn m fi -- • a'
_- - . cncnDOzzcnrn - 7 - A - S • M O Q ms X D C0 ;K . (7 -4 • UD m � r
r . OZ . f mtn . m , y cn m > cn
ou
U7 .. .. .. » .. M .. S t51 •� �. x n O
_ 9 cD �. O
i T M
G� z
�
-�
ON
cm m D
�-`
cD D < < Smmm �, _ \ I
y .n S az D :0 m
C 1J -4 -1 '-1 z z z
Q �45z > -cC
�- IDm0 zts
r� � „ � j
m . omtst (n
o x o m z
a ea
! m a
A O -0
141Q I 29 � i9 °9 L4 C4 t e. .rmw T zz 00 Q
v 1 cr v+ v v
t _ CA ILA _ OD
�a
m m ce
00770aTm ✓� r � Qm D
> -im000 <
O = r• CO > Inca
-• 3 < r
*� m 0 nt Q -u Is t9 CP co im r
`' = Q3JClr" Fn (n } t I t i rn
_
-° _ Z
rZm p � =- ^,
• SSSxz -- � � � m
—jza cl
m rC-
-i -1 D h :7 m a Zt 'CI 'v 0 7 N 0
ISt Si ?9 fs 9 m Sk t a C
1 O
5tt9t9 t 9 r to r
o o
=_ maz rn > c ca
i C 1 —; m NNN
as D S I I I�
.•fie.o '� .+ •- i 1 m
�T r m
re�s I
-' Z
�o
Co
r"
CONCRETE MECHANICAL MOBILE HOME
Footings-Setback date by Ribbons
date by Gas piping date b
Foundation Walls date by Set Up
date by INSULATION date by
BG/SLAB Insulation Floors Final
date by date by date by
FRAMING Walls FIRE DEPT.
date by date by
PLUMBING Arc date by OTHER
Groundwork
date - by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
'F/'
1. I!� ��cXS �'%�� ( {^rcN�� �(.' c /"'�iS/L�� 1 s / ADD rt / C
7— 3 / -5 -5—
j 9a 3=C n r`cn Jh- e+3E*W v-oV N f'+•a— D a-+ <>NJ 13 D M_a> a
scam — 7•- 2 • -30 —• —a- - so • v a0 (D— y c 1 m na
Cm --- Si air+ tQ3 40 S cQ0M 0000 � I
s
D a O rF c .+Q 7 w w a -
wOV Z3 -Sa 4a Zr w . f+@ wO a aw r+- 0.0 mO -;Kw
is-h O 40 a W O �=V CL r4•_7 (D 0 � '3 -S D -rl � e+
0000 <a mM V - 90 -0- -< Cl= C - 0+0 �p
0 r+-s < -v '3 v V-1= 3 -a !t7 c 4.+w v o c. — 0:0 7C 0
-- a o.v a**O m s 0's V O V C-S O M : a O -0 m rt a
Z. m- m - <--10 -03- -c - -1 � -sm C f+-rA nt
=000 a- Ca- 430 < aro3 - OOc 00 -! -1-0 Qrf. 0
0+'O CL J 0 0 a 0 a 3 O M O =r+c s9 -4s V.= go* � ---= b V L/
A-+-m - ?+0 rhW 'a r+Z M :I m - - - -M .40 IU. -V IrCD
_LOTim0 3= Oa w-O 0 = ^ s VOr+ e+ m0 <0 0- 9 a r"OD � � I
12 eD-O ,9*+ am -IV r+S-r+ a=3 0 CL 7 a a M -I
-s CD -r '3 a to w m w 00 - Orr C,7 O -
<z ms Cs suxz3 c = arc 00 (Avi Q � 3rF
I x se •+� O P+m * m rF m a t10 a= 0.+ D V
r►•+,� 2 -- a - am ®= a-- S= * z 3c OM Igo 1
-a* - c r* -s- = s Omo C cr cn on
O - 0 C M— W a P+-)c ca no MmD �
to O.0 O r+0 O-AD s•+to CL- m Ci r+< 0
C630c a0 =r_ occrr up=re+ om< e+3 s —m - -V Z
® Orr- -0 ar+ -toe-► -aka -` a as 0 -0 0- :�
7 G •7 rA rF - i�-• v^ O 0,7 11 m -S-? = m i O rIS
9s=O aE F+0 C -'� - - (a r+ ca to -b X O < Y1
_►Z Q 0) m c ? -- -e+- c yr a -S r+� ''a
e+ as pew rao 0-5 .Ors o 3-
3 O O '+ 0= c 3 m Ci z s a r► -s a : � 3t m
M -k-O a a+ Q ar+ a- -? to -- Mr+a O
= rt m,O a4 a0 -s a r. w--•a << rt (,)-:
r+Eb a cr L3 r1 - 4i Ir-z _%Q at 7 aA (03 m ? l9 O to W
I W- M 010 a 3 Q.?90 P+C -0 a zr+ Q D C/) c�
I I• b O Cr- 9a rr Z x r+•O O Q'D 9a r+ = rD
9C 3 m= --m -0++ -Cf -3 7 r+m M. o® O0 Q O
O= 1 O-6 c a 0 <a « m --- D 7 r+ ru � � ..
x- a a 7 a� a O -s Q�:9 rA M r+i8 s f+c ::)
(. V o- a w OL << - a `<G - 017 cn �- D
m< r•F -i- r+ O c c M -r+ - V, 3 O 9Q ? ZTj
0 Q'C s 0.0 -bsrF 3 ro ff � r+a
Q W +�
O <a r+-a 9 a0 V < rr
7 O ZE O ^� r*< to rF - - -. v -6 O 9C CL Q
D fl
a< m O M G- a0 V In -?we O Qc = -, = -3r• r+ m< < _ >
C^ a r+ "f _TV 1Q.+ sx O .+ 0 ra to
M, c O ® .-+-s rr _-t 3 r+-p� rr O � -•to 90 'O 9l --3 Q. a C as a s � � �
r+
0 -- a 0�
<mm o 00 - =m (Q
•+Om aM9 a c m aw
7 cz O ma Ii-- GO0 -s- -S - ? Q C►
-s *: —rr 90 =— O x 3*+ 9a m rr — Z) C
9a V a ff r+ + ra - -=r < tQ C 3 -•�7 =
a sc c r+-+ -5 IM —�c Q r+�o r► a 96•+ a -s o 10 Q D
00:+11! —s mO :5 f+ co
e'±C a V a- rD x (0 p C D ff < r+ O C (.JI ••
5 C.O Q to 0 w aD 10 3 o 10 M (A- m 00
o ra a c _-s :t f+3 ID f rf r+ o 13
tv V nm Om(D m< O -f 2) -a 0cn
rD IE 0 0-1 0 - O -7 L r+ e+ -0 41+ a m -!•+ Vi
3 O 00 -a rr It a r D 3 D Z e+9s -
17-O dl''v = 3-7 -sID O afD J 91�+
a - 0 cc c a s - rr•+ w vy ae rr M
I 3 Q CL-i+ a.+ aD � C r!- 9e 3 O C c O 9u is O p m
onQ ip� a09s rh = - Q ai
C rh 7 Sti -a-6 7 M m 90- _T m C
w rh to 90 -C V O r+ ff Cr. --f
-f m O TJ rr 9+ 100 4-6-s p 7 < a
-6-,ca am cc^ c—a -s 3 �3 R
053- 0 ID a QUO Zoo 0m n 0 G{
3aw - . O 3 -a -r+c3 a1 aD 3r%
M O O
l
I
-iWN-n�Jti✓ x —am-4 vo an MO x �1--i X=D >=OD=•ST x
=• - C=• a a a a• rn0 �b O a>• I --� r:)r zc(jlni'rzDC
m =D 0 0 0— Mz am OD '+z 0 r,7- 00—Mu<z
t3-,-i co-i v—"7 m A 0 AL !D n: <C C C M M Z A m W
>=-=-= d -NO _-! D- QtO -C -O 'Boner C
no=rnz- c.,ct,<D -1= '0 < 2 t Cam =O OWM_!rnDD
O<rn=000 -a - zc - rn m(A M rill -imrnr.-.)-vz
m- - nO mcl 0r+0 ' - rlVn -vnm--ate
to D D W•ST m 0 -0- 2-4 <=O -+ Vl - Ri--i 0 �z NO
(nm-aCrC a a 1tD -i- M 0 aO aa? z:v
'a—D— (D A O a m w m -♦C W-no M<0
=o>rzr r+. r+ DZ C- W 7'v coo z= rn
0ZZ v =r z 7a 'O � ]c a -{ O rn-rb-+
0 -+COZ A A(.o--` = M O zmCOzw
- a-i 0 0 mD a co coo w z m-n-co--
s V7 n r+D z O Q n -•< cn Z I =- = C
CO- -M W 3 0 � rn-1 WC
> no(j) —C 010 MO O <a Ow C C')ODC4=rnz
N:? = mO <-7 0!n =TO -►a 7•i OD m=-
Dn-ivco a•;w c ^) c=C a zto -1 0
rn=-rn c-< -! O--r+= _4M=(n o
_:.(/) nz- o O Mm ' =vn-io:
MCI DZ tD 0 -ha CD r a-- r•+ rn � D -ias=� i
CO 'a"Cs) < • -� cm a-m a Q O , r no rn
-qz-1m D=
00 D tD 3 <O -a -w o =-ioc
=9C_--i-O a;a vT asp -Q a =_- a—
qQrT:='ST 0 r+a - D na 0 cD x >OV,=r-
-i Ornm ! -3-= zrn 0 'J a In--i =rnO
oO• -< msz 0 0 0 0 a 20 i �•Tar. x -:Omx)snz Q Q
zrn 3 0 -s a 0 s � 0 r Om
-nm (n v a,:•m-- on JD 0 �, rn GO-0 a US cn
-rn 4 -cn : vo r+y - m rrs zov I O
= AW —_ O= rn= 0aa o -i = _Vc
mN r< aQ a(D `a= c m p-i-p'+r=O O
M r 0 m xM 0c00 r•+`7 D Ar-=om X c)
M - D-i 10 a 0 r.+ � L7 O -1 O ••?•' a• r- 'U CST rn O<- Q
O x -i= 0: 0 t@ -! a -,y Du O r- o r-i z-_
-IS -rn a O.c 06 m A x (D -c C4r1lM--rvtn OD OD C
O r+s0 a v r+W D-r -w r -4 v-mm
av z-n 0 0 r+(D 0 o W zoo Cn
cD rrl - -1-rc f+ D C 0 n is f 3 0 D D nz O -r �'
o= -7 0 n a 0 ® m a v = - CD �
--a rM 03 CDc P+ jD0+ a?+ r 00--4z^
CA2 =C C O ]7 --na (D M-noz z Q Q
(D U) -r+ rn 0 O m �a * �� rn =m C4 O
mo =D n r+-C 0 a e --0 --- O cn-i CW D (C)
=C rn= Ir a"f C aca-3 r+si v (n=-irn c»CD
C
1 _
O -7-M - r+r+D ?- rn M 0==
o= :*= -IT 0 sr <�- a to 0 0 ---
C
z0 D> 0 sG C m -- c Z-.O"t>c)
-i-f M z !A c9 r=lM 0`
Wm w�� Zr ua n v --•r-+Oz►
m-i C .+3 a3 nr c (D a -; -1 - <Cl)z (Q C
= WCD r+- P+ W - cD - C rn(=z- -C
rn m •<i. $r+. e+ s1C r+ sty Z G) � O
x to m n $ .+ m 3 h -a- C-tr. (�
�0 m 3 m q 7 3 ="-n>orn D N
M= r"•-i a ac W 1 0 r+ v m -Oornzn
=0 X 0. to O a "1a o==o -i 10 Q
—L -! rr+T Z n O O— Wx ZA— Op Q
0r1r mO r+-1 m <IN D (no Ol -�
=ni O 0—a -imz0 z OD
-i 00 v^ c 0 — 0 C_<Cl-i A
C S r+'7 z t0 a - C O Um
m -1 v Z T 0 a
2 rn t D tB= m -+p =;Cm
rn ca -r.+-a+ W rna W-a>
mOr<. C ? t6C cn -Crr
r DWmm-r'-
v z 0 n z-<-i
X--4 O r-
z �o _=W /y «
J r-n V— f/ •J r iJ —
r+ 0 r z O i
r'
n t--i
- ca m
Z A
7