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HomeMy WebLinkAboutBLD98-1043 RES/GARAGE - BLD Permit / Conditions - 12/2/1998 77 f, S 71 00 c: 01 71 7M 10 00 C) CYI vc 00 -Ab- CONCRETE MECHANICAL MOBILE HOME Footings-Setback date — �j "�! by Ribbons date /-- 4 —f 9 by Gas Piping date b Foundation Walls date by Set Up date %--;�aAV by INSULATION date by BG/SLAB Insulation Floors Final dates by date by date by _� ,�l" Walls FIRE DEPT. date by PLUMBING date '2 _ �` by `� OTHER by Groundwork Attic date by date by D.W.V. WALLBOARD NAILING date �! f� by date, 7'---TO- ff by .c Water Line FINAL INSPECTION date 09 f% by dateCJ" �,r—_ ��� by date by 14S ell jo Ar _ � � < Z 2�1 C < < Zl� C: �x T co'v 00 7 ol co 0 Q cn N) T -0 QL S 00 C) Cli 00 X—7 > 7— 17� Qt Z�IT z C, zmz IT-de va :Z, 77 < C� is rl -z Zr 7i Z 7�, x > Z> 0 OD ol >> cn X< > Z7 cn < cs< 0 ter' 10 CYI OD —7r, z -> >Z zn o Q O D O 00 O o ol c x :3 N Q O � � Z tQ % CD ' 1O Q OD 0 Q OD J� I r. •..;s.� . t^ ^. J PERMIT NO.: BLD MASON COUNTY a; BUILDING PERMIT APPLICATION /a/Z/ 426 W.Cedar/P.O.Box 186,Shelton,WA, 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482 269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACT R INFORMATION Owner k i Contractor N me Mailing Address F Mailing Addr ss l City (11kia StateclE Zip Code 4 City State {,�_ Zip Code Phone Other Ph. i4Z( Ph. Other Ph.(� Lien/Title Holder Contractor Reg. # Address Expiration SEPTICIWATER 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. / / 3�_) _ Fire District Legal Description ,+ Site Address(Please include street name, street number'a_nd city) 10 Directions to site Will timber be cut and sold in parcel preparation? (Ye o Is your property within 200' of the following: Body of Witter(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Rul off Stream Slopes or Bluffs TYPE OF JOB New d Alt-Repair Other Uselof Building Describe Work ���. No. of Bedrooms No. of Bathrooms SQUARE FO TAGE-1st loo 2nd Floor 3rd Floor Loft Basement Deck Garage Carport Other sq. ft. MOBILE HOME INFORMATION-Make Model Model Year Length Width Serial No. No. of Bedrooms No. of Bathrooms Type of Heat Purchase Price $ 1 Replacement Unit ?(Yes/No) Installer Name Certification No. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHO IZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. The owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the above described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTORIS 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 aware of the ordinance requirements for which t*permit is issued and that all work will be done in requirements regulating the work for which this permit 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 roval. X Date X Date . FOR OFFICIAL USE BEYOND T IS POINT Accepted by �, Date Submittal Amount Due Receipt No. ...........:........... :..:::::::::::.;;.;;;:.;:.;;:<.;:.;::::;::.>;::...:...:.:...:......:...:.:..}::.:....:...............:::. PARTMENT L.I E IEW.: : :::::::::.::::::::: U .NIED.............:::.:.:::::: .::::::.:::�t�f��IT�....................... .... ............................... ........................ Building Department W k1F_- - C6^Qp ' Occ Grou Type Constr. ` .. 11-Sb Planning Department Environmental Health Department Public Works Department Fire Marshal R90 re -5 Valuation 1--:9 = a `T/ n T:5-/ ..:.......... Building Permit Fee jt'"' Site Inspection Plan Review Fee .- UFC Plan Review Fee Plumbing & Base Fee a© Public Works R view Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Sub ittaI ( ) gig ig-'sf*S L � �'� �}°�,� r �<r :0_ � r ?�A TOTAL FEES PERMIT NO.: �� f MASON COUNTY PLUMBING/MECHANICAL PERM T APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482- 269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner ! Contractor N e Mailing Address'�r`-f. ,x Mailing Addr s City � State— Zip Code City State Zip Cody{ ' Phone( Other Ph. Ph. Other Ph.( Lien/Title Holder t . - Contractor R, g. #�jAl� �11�12z�._ Address ^" Expiration / f SEPTIC INFORMATION-Connect to New Septic _ -'existing Septic Connect to Sewer System Name of Sewer 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 Is your property within 200' of the following: Body of Water(Name) Saltwater Lake River/Creek Pond Wetland Seasonal Ruooff Stream Slopes or Bluffs TYPE OF JOB Newer Add Alt Repair Other Use of Building Location of Fixtures/Units 1st Floor � 2nd Floor Basement Garage Closet PLUMBING FIXTURES(Show Number of each) MECHANICAL UNITS Fuel Type: Electric Type of Fixture No. of Fixtures Fees LPG_ Natural Gas Heatpump Toilets Type of Wnit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers Vent Fans ----------- Water Heater Propane tank Laundry Wsher O —9 op Gas Outlets Sinks r r Wood/Gas/Pellet Stove Dishwasher u00 Direct Vent? Other At Q 3F_b.Q;L_&6 51' .0 Other Other Other Base Fee 4Q,Ua Base Fee TOTAL PLUMBING too•©d t TOTAL MECHANICAL 00 A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENE I G ON THE TYPE OF FIXTURE/UNIT. NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHOI ZIZED IS NOT COMMENCED WITHIN 180 DAYS OR IF CONSTRUCTION WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER THE WORK IS COMMENCED. PROOF OF CONTINUATION OF WORK IS BY MEANS OF A PROGRESS INSPECTION. Tt e owner or agent on owner's behalf,represents that the information provided is accurate and grants employees of Mason County access to the ibove described property and structures for review and inspection of this project. Acknowledgment of such is by signature below: OWNER AFFIDAVIT-I certify that I am exempt from the requirements of the CONTRACTO 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 aware 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 permit 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 approval. � X Date X jr CA�' / q Date / FOR OFFICIAL USE BEYOND T HIS POINT Accepted by Date Submittal Amounti Due Receipt No. DEPf#Ft1 NEE1dTAt #i1^V[ 1N ''APPROVED F3ENIE{3 GONDITlftltil'CC�CJ7^S Building Department Occ Group Type Constr. Planning Department Other 71 Other E..:> .................................................... Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fe Plumbing&Base Fee Other Mechanical&Base Fee Other Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( ) Violation Fee TOTAL FEES -e,-O-V 0 ZD, 0 ELMA , vo A C) 2.(,-�8-7(, uj 41(.-I 35 Xv : S. -\1E L-T 0 t\,) ; w 71, Z- -p 2*z)<Zo Hot -1-19-za 19 5CALP-: 1"- 40 THE IN ORMATION ON THIS PLOT PLAN HAS BEEN PROVIDED AND REVIEWED BY THE PROPERTY OWNER WHO,BY SIGNING BELOW:1.1 ACKNOWLEDGES AND ACCEPTS FULL RESPONSIBILITY FOR ITS ACCUM AND COMPLETENESS:2.)IS RESPONSIBLE TO ENSURE THAT THE IMPROVEMENTS TO THE SITE TAKE PLACE IN CONFORMANCE WITH THIS PLAN:3.)WILL ESTABLISH ALL THE CORNER IRONS,LOT LINES AND CODE- REQUIRED SETBACKS REQUIRED OF THIS PROPERTY ANY CHANGE(S)TO THIS PLAN MUST CE PRE-APPROVED BY THE GOVERNMENTAL A1oD,1!,IES WITH JURI':DICTION,I HE MIORTGAGE ENDER AND THE CONTRACIRAND DOCU:ME TED. .x ZLZ2� OV R DATE bwNEkj-- DATE FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION ✓J� I ' Case No. Name U11 q OK U.( �—Kiln(SA)PARCEL NUMBER 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 within 100 feet of adjacent property line. adjacent property line- I I <—adjacent property line I I I 1 I I i ,C I I I I I I I �^ I I I ® I I I I I I I I i3' I I �2 I I I 3�S I I I I I I b�� r'►, [�� I I I I I adjacent property line--) I ' <—adjacent property line SAMPLE SITE PLAN adja�nt property line-� 310� _ _ _ E-adjacent property line D 3a• rR4 RvE gel co.iwL L �Pc�c—_� I• ti 1. CREEK \ I � fi Hone tr I Gga6n.i ]I I F �•. --r— i Hau3F. I ) PROPo3GD s�Qt L �I 1 , I I VAGrvT I C nrtAa� I i I e I , I 3 DM1oPo1Cf) ____����II 1� \ A&RICLLLrL MAL $O I 1 I I I \\ I I � I \ i /00" I I i L—eLL I I I I I L..�_LL I •� I 1 (C I I � �"Ilk I I adjacent property lined \i Fad'acent ro ert'line TOPOGRAPHY PROFILE(Show a side view of property. Show slopes, cuts and fills. If possible include height and the degree of slopes. See sample topography profile.) SAMPLE TOPOGRAPHY PROFILE dtstar.cm fin SrF ruttl.�YG d�3't'ar.GG tc eel } g� dis�ana2 p to Signature Date MASON COUNTY DEPARTMENT OF HEALTH SERVICES Date // PO BOX 1666 SHELTON, WA 98584 LOCAL(360)427-9670 ELMA (360)482-5269 —�^ BELFAIR(360)275-4467 FAX (360)427-7798 lm� . LA 9&T BLD_9R —10y3 PARCEL NUMBER '/Q00o'3- - I5--00030 Your Building permit cannot be issued by Mason county Environmental Health until the following items are completed and turned in: ♦ Application of Water Adequacy. ♦ Approved septic system records/approved septic design for ♦ A complete and accurate scaled plot plan which shows all buildings (actual & proposed) driveways, location of septic system, location of reserve drainfield area, wells. i ♦ A report done within the last three years from either a septic tank pumper or from an Operation and Maintenance Specialist. ♦ A copy of a recorded Certificate of Residential Use for 3 bedrooms. (Sign and notarize the enclosed form. Then either return the signed and notarized form to this office with a check for$8.00 payable to the Mason County Auditor or take the signed and notarized form to the Mason County Auditor's office have it recorded and bring a copy of the recorded document to this office) ♦ Other 'r If you have an estions, please call me at extension 358 or Pam Denton at extension 554. Sincerely Carol n J nsen/P m Denton Environ ntal ealth Specialist cc: File Trish Wagner