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HomeMy WebLinkAboutBLD97-0782 MFH - BLD Application - 7/7/1997 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 jj�� 97 (Calling From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269) (1W " PLEASE PRINT #1 Or Phone#(31oO "E2.Lo 01 Site Addres r R.C. . Fire District# City St (k Zip Directions tc Job Site Du.k y� u. -'-� `fiiA 1 l%J (r v Owner Maili g Address \,-sJ , 2O1 C..4 City 1J3 P St Zip Lien/Title H Ider Z y'm '3 ctf Address City St Zip #2 Contractor I ame -+1� Contractor Reg# Address Expiration Date / / City St t,d-'- . Zip '; ' Phone# #3 If septic is k ated on project site, include records. Connect to eptic? e Public Water Supply Well Connect to ewer System? Name of System (If residents I, proof of potable water is required) #4 Pafcl No. - j _ - C?© 3 egal Descr ption Z TT . 3 v_ n i ` gel ,., R.d ¶P3 o fi S f' 2�z5 #5 Building Sq are Footage: 1st Fl 1$ 2nd FI 3rd FI Loft Basement # Bedroom _ # bathrooms 'i Deck 1 �( _0 Other Garage Carport (Circle:Attached or Detached?) #6 Use of build ng I( 2S c € Describe work #7 Type of Job New✓ Add Alt Repair Other #8 MOBILE/M NUFACTUREQ HOME INFORMATION Model Ye ake del � � ��a►` blrld Length WidthZSerial No. #Bedroom # Bathrooms _Type of Heat hLGtk �unp Purchase P ice$ #9 Indicate by irclin the applicable source if any water is on or adjacent to subject property: River Pon Creek Stream Wetland Lake Marsh Saltwater Seasonal Runoff Other Show following on the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Drainage Plan Wells Septic Systems Easements Proposed Improvements Indicate Directional by (N, S, E, W) Name of Side Street Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW - Q• _�� n{ c,; ,' �Xs�st,ti,c� �Ctrn Mobs(e , s2�$rt, 100 To gas w% APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW 4 �--� pp� 6 Pluming Fixt res ($3.35 each) Fee Mechanical Fixtures ($6.75 each) No. Toilet CIRCLE FUEL TYPE: Gas, Electric, th asins Heatpump, Other Bat ubs No. Units Fees Show s __ Furn BTU _Hot V a Htr _ Hcatpumps Laun ry Wsher Vent�Systems Sinks — Spot Vent Fans Floor rains No. Boilers/Compressors —Laun ry Basins — HP Dish asher No. Air Handling Units __Dispo al — cfm# Urinals No. Fire Protection Systems Other ` — Auto. Fire Alarrt Sys 50.00 Fixed Fire Supp.,.Sys 50.00 Perm sic Fee 16.75 — Auto Fire Sprin) Sys 35.00 TOTAL PLUMBING $ Na Other Gas Outlet- - Wood, Gds, Pellet Stove - f NOTICE: THIS PEF lIIT BECOMES NULL AND VOID IF WORK OR CONSTI UCTION AUTHORIZED IS NOT COM- - MENCED WITHIN 1 0 DAYS OR IF CONSTRUCTION OR Permit Bas ibI Fee 16.75 WORK IS SUSPENt ED OR ABANDONED FOR A PERIOD OF 180 DAYS AT NY TIME AFTER WORK IS COM- TOTAL,MECHANICAL $ MENCED. PROOF F CONTINUATION OF WORK IS BY MEANS OF A PRO RESS INSPECTION. OWNERS AFFIDAV T CONTRACTORS AFFIDAVIT I CERTIFY THAT I M EXEMPT FROM THE REQUIRE- I CERTIFY THAT I AM A CURRENTLY REGISTERED MENTS OF THE C NTRACTORS REGISTRATION LAW CONTRACTOR IN THE STATE OF WASHINGTON AND I RCW 18.27, AND A I AWARE OF THE MASON COUNTY AMAWAREOFTHEORDINANCE REQUIREMENTS REGU- ORDINANCE REQI IREMENTS FOR WHICH THIS PER- LATING THE WORK FOR WHICH THE PERMIT IS ISSUED MIT IS ISSUEDANE THAT ALL WORK DONE WILL BE IN AND ALL WORK DONE WILL BE IN CONFORMANCE CONFORMANCE T EREWITH. NO CHANGES SHALL BE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT MADE WITHOUT F RST OBTAINING APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DEl ARTMENT. DEPARTMENT. O� ER X BY DATEI DATE FOR OFFICIAL USE ONLY:Accepted by: Rate:' DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review 11)/J j/2I . / Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Violation Fee Site Inspection Building State Fee Other N 1). lLn`}L Other Other Building Valuation: TOTAL FEE ,c l) GARY YANDO,DIRECTOR ON_3TgTF s U DEPARTMENT OF COMMUNITY DEVELOPMENT O N - PLANNING - SOLID WASTE - UTILITIES N Y BLDG. I • 411 N. 5TH ST. • P.O. BOX 578 1864 SHELTON, WA 98584 • (360) 427-9670 DISCL R/WAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVI ION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS: The undersi property owner is aware of the uncertainty regarding Mason County's development regulations created by the Grow h Management Hearings Board's Order of September 6, 1996, and in consideration of Mason County's willingness to proceed with processing of applications which might be affected by that Order, the undersigned property owner hereby agrees to waive any lawsuit, action, or claim for damages against Mason County which may arise out of Mason Co 's actions in acceptance, processing andlor issuance of such permits or approvals (hereinafter"permitting actions"), whi h damages are attributable to the County's decision to take permitting actions despite the risk that changes to the Coun 's development regulations might later make the County's permitting actions invalid. __ !A q c Date (Parcel No. or Legal Description) Property o er's signature(Notarized) (or the Coun may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNO DGEMENT CERTIFICATE (INDIVIDUAL) STATE OF COUNTY O On this day of , in the year , before me Notary Public, personally a peared personally known to me to be the person whose name is subscribed t this instrument, and acknowledged that he/she executed it. WITNESS y hand and official seal. -For County use only- 1 Reviewed by applicant on (Date) Notary's si ture Staff Initial: My Commis ion Expires: From PHONE hdo. . 765 c7 No.... 03 1' g. ESN POI J t N u7 T $ HH E LTC�N / WA- S/A4 P�u n/ A•-3S 1 - --- - - ,#sS ►AID�F.�' r' �1 r t�IE' (2)2. WI W I O NA /L.S k Z L 1 'LI`i,t.' r�:�7'YtCrA f S1Mngr}r,1 �-U 9 Jv i ST ,.�r�V•.1 •s ----•...: 'Y $T c,r7-S A"T ' a hJCi t• t ( ) JIQ .AIAt�-.`�' '�`�rtiJ lifl•G �,{ '"rY�U.S S• C-�c,7T"'7`G+�-1 C-�-�t'��,4 T 4, p-,fa�t�t SCE t tz �V I