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HomeMy WebLinkAboutBLD99-0753 - BLD Permit / Conditions - 3/10/2000 7b 4�' Y�ws w YG 'Ry 9 t "*1 w r:e J �i '"., --�3 ..� "+.• "I; z `si ari > 0 Cr z ,,:a .;y am �'�.. «'",s -1 ".r' z 7, z FI ..'=+ v, > — ,gyp /y�� O"5 'a as .a -� W i r < n "2 yt 'm rr T = Cn '+. . i5w t$3 ..., i z Z /�yl� /�� a-3 ... is �.ir fi C +tea r V CO /W/; �.L f[� as �J .x. .!•" .-a .� :r .,n 'v00 in M ; v 14 `^ kyp w IE -E t 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 FRAMING by date by date by Walls FIRE DEPT. date by date by date by PLUMBING OTHER Groundwork Attic date by date by D W WALLBOARD NAILING date by date by j Water Line FINAL INSPECTION date by date by date by >7: + r 21 7- _73 !a; >V) ri z Cr 7!z-17— 07 0 z U fit le 0-0— W OD C: 0- V-2 Cr cn N) m> r1ni-r '77 z z rIll nL'n C=1 Z I> -0 z n S an - 0 Z vi ..a z 774 Z--p { Cie X.z 7M Z-n w >,z In -0 rizo OD Z7-n 0 �pst O '} q". "" i J .t[ T �• >. •R rye ^ OD { a . . a -"z Se cr z 0 n a S T z z 7 PERMIT NO.: BLD ` P�/7� / MASON COUNTY ., BUILDING PERMIT APPLATION I 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elmo 360 482- 269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner Contractor Ne me Mailing Address Mailing Address City State Zip Code City_ State Zip Code Phone( ) Other Ph.L___) Ph.(_ Other Ph.( ) Lien/Title Holder Contractor RE g. # Address Expiration SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System -�Well Water System Name of Water System PARCEL INFORMATION-12 digit,Tax Parcel No. / / Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site x Will timber be cut and sold in parcel preparation? (Yes/No) Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Rur off Stream Slopes or Bluffs TYPE OF JOB New Add A- Alt Repair Other Use of Building Describe Work No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attache Detached MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. ol Bedrooms No. of Bathrooms Type of Heat Purchase Price $ Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHOF IZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS T ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Th owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the a 3ove described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-]certify that I am exempt from the requirements of the CONTRACTOR S AFFIDAVIT-I certify that I am currently registered as a Contractor Registration Law RCW 18.27 and am aware of the ordinance contractor in the State of Washington and that I am ware of the ordinance requirements for which this permit is issued and that all work will be done in requirements regulating the work for which this pernhit is issued and all work conformance therewith. No changes shall be made without first obtaining shall be done in conformance therewith. No changes shall be made without approval. first obtaining ap poval. r X Date X ,' ! Date r FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount ue I Receipt No.f, DEPARTMENTAL EVIEVV APPR©VED DENIED CONDITION C;:DES !; Building Department /`t p 1l cc bm 6 Occ Group Type Constr. 5&) 3 3 Planning Department _ 56 \RM� IFok k- N o Environmental Health Department Public Works Department i Fire Marshal Valuation $ ll!�3 a . 0 . EES _.._ -- _ ..... ... _ _. - .. ...... Building Permit Fee Site Inspection Plan Review Fee y+ �L UFC Plan Reviq w Fee Plumbing & Base Fee Public Works R View Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Sub ittal ( ) TOTAL FEES MASON COUNTY PROJECT SITE INFORMATION �� Case No. Name PARCEL NUMBER Date SHOW THE FOLLOWING ON SITE PLAN Show Direction by indicationg N, S, E, W in relation to the site plan Lot Dimensions Fences Existing Structures Driveways Structure Setbacks Shorelines Water Lines Topography Well Location (including adjacent) Drainage Plan Names of Streets Easements Names of Fronting Streets Septic System DRAW SITE PLAN BELOW Include adjacent properties if on shoreline or ithin 100 feet of adjacent property line. adjacent property line4 1 _� �djat�+ 'line 1 Well Htiw Er,,,45e I � 1 I I I I I I I L I 1 1 I' I � I I ! r I X i I I _ I pol I ,s` adjacent property line4 I E-adjacent property line ..... SAMPLE SITE PLAN adjacent property lined 3zo E-adjacent property line 30- r — RVE I s�,J AL. — Cf2EE1G I C 7 HOM t I Cs46.E�J 1 PRoPOSGD s¢pt; 1 _ bo' pit I V11Gn,T fi c nrtAc.E I j/ I(� I C0.ofosefJ So' ACrR SLLLLT A L I i 1 � I I � I I I � c..ALL I I I I x /00' —� I I f1 'eII 1 adjacent property line-;� ; 1 A"• \i <—adjacent properi�line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cu Is and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE I OPOGRAPHY PROFILE d15+.2nc.a. fin ShruttLa.►Ye_ diS'far+LL to Signature Date