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Home My WebLink AboutBLD97-0267 Cancelled - BLD Application - 3/13/1997 Permit No b\�v0 MASON COUNTY UILDING PERMIT APPLICATIONS 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT #1 Owner Mflic ( 104A/ COkZ-,=-'- Phone#- -3 Co +2 6.8717 Site Address Lor 6Q , 9&, 7A t 7A 111/CI-XES7- e$77W 75, uN/0^/ Fire District# City UNION St h/A Zip Z Directions to Job Site 99111,6 J,-0kV, 9V.-%- y-OVIoN O!✓ /'7c1/Zt&- 41/ S7AAZI- 10 Coo Dow PIS 7',PwArzOS Or J A77oN , yy�G�T �sT•dT.�S /S A G.Vfr 0Fe /+/c CkcAIAK /=o[Loh/ AA'4P To TOP or- �/�LL . to7'ts or✓ lIg R14rhT. Owner Mailing Address Z 300 /C A 7-7 Ca11tZ7' $//1r& C f 0. a0-1c 5 9 City St 414 Zip 1� Lien/Title Holder IVIAIF- Address Clty St Zip #2 Contractor Name /✓ ontrac Reg# Address E ation Date City t i Phone# _ #3 If septic is located o pr ct I clude ord Connect to c W Sup p ell Connect to er S st Name of yste (If residential, p of of pot water is require #4 Parcel No.3'p-)6 - '94 1�'v Legal Description VlffifR�'l 05rA►F,S LdTs 6'A-61 �Gll B Tdw/vftllr 2/ /VOR�/ RQ N(yE 3 w sj' 5;EC-'n0nr (e FE ;14 Of IVE /¢ /l�,asi„/ LavN?`•f #5 Building Square Footage: (existing/proposed) 1st FI / 0 2nd FI / l 2,713rd FI / 70 7 Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / 96B Carport / (Circle:Attached or Detached?) Other sq.ft. / #6 Use of building RE5;/WdCF, Describe work NP-u/ WOOD FCJS MS RV4tDE--�1CF #7 Type of Job: New _Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION 1Aj � Model Year Make Model 1 Length Width Serial No. MAR 1 3 1997 #Bedrooms #Bathrooms Type of Heat Purchase Price$ ;HEALTH S:�RVIC'c #9 Indicate by circling the applicable source if any water is on or adjacent to subject property: �✓ River Pond Creek Stream 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. F1 b$ S h APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW �o QV�1N Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. 3 Toilets CIRCLE FUEL TYPEQas Electric, 4 Bath Basins Heatpump Other Bath Tubs No. Units Fees 3Showers _ Furn BTU Hot Water Htr _ Heatpumps Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans _Floor Drains No. Boilers/Compressors _Laundry Basins — HP I 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 16.75 _ Auto Fire Sprink Sys 35•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 16.75 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 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 WORKFOR 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. ,4�,,,'. X OWNER X BY DATE DATE 311¢1 , DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: I Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other Building Valuation: TOTAL FEE APPLICANT NAME: DATE: L BUILDING PERMIT CHECKLIST [� SITE ADDRESS If site address has not been issued refer the customer to Community Dev. ext 291. [✓� FIRE DISTRICTS Please make sure the fire district is included in the application information. Refer to map located at counter. 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.?). LIEN/TITLE HOLDER Who holds the mortgage (Bank or name of private owner holding contract)? CONTRACTOR REGISTRATION # AND EXPIRATION DATE This information needs to be provided. The Building Department may be able to research expiration information ii customer does not know it. We must have a signature in 1 of the 2 boxes, either the applicant or the contractor. SEPTIC RECORDS New systems must have test holes dug prior to submission and Septic Application must be filed and paid in full. WATER COMMUNITY PRIVATE SEPTIC EXISTING (-CDESIGN APP. DEV REMODEL NEW STATUS IS THIS A REPLACEMENT UNIT? YES N IF SO: MASON COUNTY BUILDING PERMIT APPLLI�N SECTION #5, BUILDING SQUARE FOOTAGE, MUST BE FILLED OUT COMPLETELY. AND: SECTION #6 MUST CLEARLY STATE, "REPLACEMENT UNIT" PARCEL #/LEGAL DESCRIPTION Parcel # must be included. If number is not available contact Addressing at Ext. 291 BUILDING SQUARE FOOTAGE Clearly show existing square footage and that of which is proposed. If there is a garage, verify whether it is attached or detached. Include square footage information for mobile homes.(ie. 10X20=200 square feet.) USE OF BUILDING Residence, garage, greenhouse, designate if it is commercial. DESCRIBE WORK (i.e. mobile home addition, addition to a house, etc. . .) TYPE OF JOB Verify appropriate boxes are marked. 1 MOBILE HOME 1 O "ON Verify appropriate es are marked. If factory order, please put factory order#in mobile home serial #. If unit wa assembled prior t June 15, 1976, refer to procedures handout for "Obtaining Installation Permits for Mobile Assembled Prior o June 15, 1976." 0 SHORELINE ND If propert "y is wi 1 00 feet(includina adiacent properties) of Shorelines/Creek/Wetiands, #9 must be complete. I none of the c ditions are present please enter "na" or "none". [ SITE PLAN DRAWING MUST SHOW THE FOLLOWING: • LOT DIMENSIONS • DRIVEWAYS • EXISTING STRUCTURES • SHORELINES • STRUCTURE SETBACKS • WELLS • WATER LINES • SEPTIC SYSTEMS • PROPOSED IMPROVEMENTS • EASEMENTS • NAME OF FLANKING STREET • NAME OF FRONTING STREET ALSO PLEASE MAKE SURE DIRECTIONAL IS FILLED IN ON APPLICATION TOPOGRAPHY DRAWING If property is flat write "flat" on the topography section. If house or structure is near a slope or hill, drawing mus reflect this. This should show an accurate side view of the property. PLUMBING/MECHANICAL This form must be completed for any structure with plumbing and mechanical excluding mobiles/modulars. OWNER OR CONTRACTOR AFFIDAVIT Owner or 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 datc 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. Commercial protects require four sets of plans. WATER ADEQUACY For new residences and mobiles. PRIVATE WELLS MUST HAVE WELL LOGS OR CAPACITY TEST AND BACTERIAL TEST. If they are on a public water system, check for signature to verify that the system is not on the State's "oui of compliance list" WSEC &V & LAG CODE 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 system). Window schedule mus be filled out and reflect what appears on submitted building plans. If applicant has decided to go with the PUD in< Long Term Super Good Cents program, we require a copy of the signed agreement with the utility. ROAD ACCE P IT If you will be a ssing your driveway from a County road, contact the Public Works Department in Mason County Building 1,42 96 extension 450. Access from State Highways requires Department of Transportation approval. Contact office (206)895-4753 (Port Orchard). "Notarized statement for GMA" Checklist.2 2-5-97 Trish