HomeMy WebLinkAboutBLD2000-00004 RES PORCH GARAGE - BLD Permit / Conditions - 1/28/2000 ® ® -� m X
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a
PERMIT NO.: BLD,2UW �"!"
MASON COUNTY
BUILDING PERMIT APPLICATION
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMATION CONTRACTOR INFORMATION
Owner Ze�i,& &= �3:� Contractor Name
Mailing Address 'a Mailing Address
City +State Zip Code $- City State Zip Code
Phonef;4� ,,,'Other Ph.( j Ph.( Other Ph.�)
Lien/Title Holder_ Contractor Reg. #
Address.5.4,g2� Expiration
SEPTIC/WATER SYSTEM INFORMATION-Connect to New Septic Existing Septic Connect to Sewer
System Name of Sewer System ... „+ °t"'�" +'� Well Water System . Name of
Water System
PARCEL INFORMATION-12 digit Tax Parcel No. !4? I2 *1/ Fire District
Legal Description ►
Site Address(Please include street name, street ber and city) +ee
Directions to site O nu Aiep
,>
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 Runff Stream Slopes or
Bluffs
TYPE OF JOB New Add Alt Repair Other Use f Building ...5
Describe Work
No. of Bedrooms " No. of Bathrooms', SQ U ARE O AGE-1st oor_+ ^2nd Floor—/f�Q
3rd Floor Loft Basement Deck Other
Gara e Attached Detached _Carport Attached Detached
MOBILE HOME INFORMATION-Make Model Model Year
Length Width Serial No. No. of 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 AUTHORIZED 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 CONTRACTOR'S AFFIDAVIT-1 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.
r , ''a.<< , .s- �'" Date ' X Date
FOR OFFICIAL USE BEYOND TOTS POINT
Accepted by Date Submittal Amount Due Receipt No.
D PARTMENTAI REVIEW APPROVED D.ENIE CONDITION COp 5
_.
Building Department
Occ Group Type Constr.
Planning Department
Environmental Health Department
Public Works Department
I
Fire Marshal
Valuation $
Building Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing & Base Fee Public Works Review Fee
Mechanical & Base Fee ker l_ n
Wood/Gas/Pellet Stove Fee Other ��""
Violation Fee Pre-Paid at Submittal ( )
TOTA::::.. :>::.:r..:....::.:.:.;::::.:::..........................:::::::::.::::::::.:::<•>:.. L FEES
PERMIT NO.:
MASON COUNTY
PLUMBING/MECHANICAL PERMIT APPLICATION '
426 W.Cedar/P.O.Box 186,Shelton,WA 98584
Shelton 360 427-9670 Belfair 360 275-4467 Elma 360 482-5269 Seattle 206 464-6968
APPLICANT INFORMAT,,19N CONTRACTOR INFORMATION
Owner M .cT ,,�!- Contractor Name
,. ,,,
Mailing Address X Mailing Address
City State z Zip Code ,246—e City State Zip Code
Phone , Other Ph.( Other Ph.0
Lien/Title Holder Contractor Reg. #
Address Expiration
SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of
Sewer System_
PARCEL INFORMATION-12 digit Tax Parcel No. BG!AY 91or / D16W 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 Runoff Stream Slopes or
Bluffs
TYPE OF JOB New K Add Alt Repair Other Use, of Building
Location of Fixtures/Units 1st Floor_.a, 2nd Floor 4 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 ,1 Type of Unit No. of Units Fees
Bath Basins ear L Furnace 3
Bath Tubs IN Heatpumps
Showers �" _�_ Vent Fans ,'" Z6
Water Heater 4, Propane Tank
Laundry Wsher 2 _ Outlets
Sinks _� '7 oo as/Pellet Stove Vz—
Dishwasher _ �_ Direct Vent?
~ Otherszte_ S_S Otherj2AWCf Naod 1 9-TD
Other Other
Base Fee l In .1 Base Fee
TOTAL PLUMBING TOTAL MECHANICAL
A FLOOR PLAN AND PLOT PLAN MAY BE REQUIRED DEPENDING ON THE TYPE OF FIXTURE/UNIT.
NOTICE: THIS PERMIT BECOMES NULL&VOID IF WORK OR CONSTRUCTION AUTHORIZED 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 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 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 ate X Date
R.
FOR OFFICIAL USE BEYOND THIS POINT
Accepted by Date Submittal Amount Due Receipt No.
DEPARTNIE1dTA1 #ZEVIE1fY APPRl7VED [7ENIEI} GONpITIQIV Cfl[JE5
Building Department
Occ Group Type Constr.
Planning Department
Other
Other
......................................................................................................................................................:::..:..:..:.:.........................................::::::::::::::.::::::.::::........................................:::.::::.::.
Permit Fee Site Inspection
Plan Review Fee UFC Plan Review Fee
Plumbing&Base Fee Other
Mechanical&Base Fee Other
Wood/Gas/Pellet Stove Fee Pre-Paid at Submittal ( )
Violation Fee TOTAL FEES
i CONCRETE MECHANICAL MOBILE HOME
i Footings-Setback date by Ribbons
date by Gas Piping date by
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 date by
PLUMBING Attic OTHER
Groundwork date by
date b
D.W.V. WALLBOARD NAILING
date by
date by Water Line FINAL INSPECTION
date by date by� date by
4 2=-
• ZDZ� liv,�� th��0 ��.vo /•trs G�Tiav '1S-
01)
r
z
v
CONCRETE MECHANICAL MOBILE HOME
I Footings-Setback date 2--I =7-CY'T' by ;1- _ 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 ppitWalls FIRE DEPT.
date Z 1S - by date by • �iJ•4:kr- date by
PLUMBING Attic OTHER
Groundwork date 2--2_1 zpOD b
Io-
date - b Y
D.W.V. WALLBOARD NAILING
e.date . -!S-2-Ov ' by date .2!�f'WOO by L .
Water Line FINAL INSPECTION
date a—/ .tJt�C> by f i_ date 2L- l by date by
,8ZOC"t A. .1ctir'A) 15d74;e17
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1705654
paps: 2 of 3
1 01/28/2000 11:31A
!' IAN HASTINGS NOTCE 10.00 Mason Co, WA
TITLE NOTIFICATION OF AQUIFER RECHARGE AREA
PARCEL NO.:
DATE: .�
LEGAL
DESCRIPTION:
OWNER.: as
NOTICE: This site lies within an Aquifer Recharge re of addeve[opm nt foyer
ect
17.0.1, Mason County Code. The site was the subj
List proposal(s);corresponding permit number(s), and application date(s):
APPLICATION
TYPE OF PROPOSAL
PERMIT NUMBER DATE
co /-3-0000
Restrictions on use or alteration of the site may exist dueito natu has rlconi ions of
the site and resulting regulation. Review of such appl�cat provided
triction
information on the location o an aquif recharge ar a area is and ther ached he eto heir.
use. A copy of the owl
Signature of Owner: .
��'�� �� �rnh�.�- C✓ �%Ur�e-s J to me
On this day personally ppe be ore e -
known to be the individual described in and who executed the within.asigned the
ng
instrument, and acl nowledged that h free and voluntary act and deed, for the
same as �
uses and purposes therein mentioned. 109—�Ocx�
GIVEN under my
hand and official seal this�6 day of �
..••••• .. Q '. go ary Public
TAR1 Expiration Date:' - C--- —
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o• ))
/1 G
i `:i Fj✓G t1c^ r County residing in - ------ —
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1705654
Papa: 3 of 3
01/28/2000 11:31A
IAN HASTINGS NOTCE 10.00 Mason Co, WA
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