HomeMy WebLinkAboutBLD97-0732 RES AND DECK - BLD Permit / Conditions - 9/24/1997 ri-
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CONCRETE MECHANICAL C I' MOBILE HOME
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Footings-Setback date �� by Ribbons 1 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 ' Walls LW FIRE DEPT.
date by date D-%60 9 by date by
PLUMBING OTHER
Groundwork Attic D
date date by �
D.W.V. by WALLBOARD NAILING )a-a3
date - - -�� `�by date 06` - b
Water Lin FINAL INSPEC ION
date by date Ivz(q b date by
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CONCRETE MECHANICAL MOBILE HOME
R'ootings 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 OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
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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 by date by date by
FRAMING Walls FIRE DEPT.
date by date by date by
PLUMBING OTHER
Groundwork Attic
date by date by
D.W.V. WALLBOARD NAILING
date by date by
Water Line FINAL INSPECTION
date by date by date by
j Permit No.
MASON COUNTY �,
JOIN IS BUILDING PERMIT APPLICATION �IDQ 2a
JfbJAedar/P.O.
Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
" aing From: Seattle 464-6968, Belfair 275-4467, Elma 482-5269)
FJ
#1 wner (;A!5V.4e G r J'��Ale 77-,e �Cej S Phone# IIS
��Re Address \A1 6o 1 '21C�.(.E.�IODO CT. Fire District#
ity S H EL-TO A St 604 Zip c/SS$
Directions to Job Site 1 CJ l TO *t)Ay foN A t z Poe-+ -PA Tu R ki LF-E-T
of A ^n,a`E ?AsS SAg-L7-o,c CoZzczr'to,0aL Gw-k4. ,ee ,-"uit,3 Rtgh.�.
N o A To �, Cs �Eu ' l a M ' 7: Good ST z E Wr C2oss /tdreRze�zi
C6 Ta :P4LA m i&1 c-> ry �r o Tu iv� --�F O,4l 0 `61Z t C1 Lf Cr
Owner Mailing Address
City St Zip
Lien/Title Holder
Address
City St Zip
#2 Contractor Name Contractor Reg #
Address Expiration Date
City St Zip Phone#
#3 If septic is located on project site, include records.
Connect to Septic? X Public Water Supply Well
Connect to Sewer System? Name of System 7774 7°'t.y7,, e e f4$T6 SAS%%r��i
(If residential, proof of potable water is required)
#4 Parcel No. Q 0 - 7790- ib71,
Legal Description j i2 10 - �35 j , 1��k- 'SurVtJ 1 5;/100
#5 Building Square Footage:
1st FI 2nd FI 3rd FI Loft Basement
# Bedrooms # bathrooms Deck 110 Other
Garage Carport (Circle:Attached or Detached?)
#6 Use of building 5. F R Describe work
#7 Type of Job: New Add Alt Repair Other
#8 MOBILE/MANUF CTURE HOME IN ORM ION
Model Year M e d
Length Widt Serial
# Bedrooms # athrooms Type of Heat
Purchase Price
#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
1
Show following on the site plan
3
i
Lot Dimensions Fences
Existing Structures Driveways
Structure Setbacks Shorelines
Water Lines Topography
Drainage Plan Wells
Septic Systems Easements
Proposed Improvements
Name of Side Street Indicate Directional by (N, S, E, W)
Name of Fronting Street in relation to plot plan
APPLIC' NT TO DRAW SITE PLAN BELOW
£I Pbo 54 L—r-�c
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b a`-�®86
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW
Plumbing Fixtures ($3.35 each) Fee Mechanical Fixtures ($6.75 each)
No._Toilets qS CIRCLE FUEL TYPE: Electric,
Bath Basins M, Heatpump, ther
Bath Tubs & 5- No. Units 9/p
Fees
Showers —_ Furn �
Hot Water Htr Heatpumps
1 Laundry Washer _ Vent Systems
SinksS Spot Vent Fans
-4�Tloor Drains No. Boilers/Compressors
j;sins _ HP
Dishwasher No. Air Handling Units
. isposal - - _ cfm#
-0"Urinals No. Fire Protection Systems
'P"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
.g as Outer w
ood���
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 2�
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 CONTRACTORS 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 WORK FOR 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. A DEPARTMENT.
X OWNER X BY
DATE �4'2 DATE
FOR OFFICIAL USE ONLY:Accepted by. Date:
DEPARTMENTAL REVIEW
FOR OFFICE USE ONLY
Approved Cond. Hold "
t - —Approval
Planning: ° i 1
vRIA 0A nA
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Environmental Health: P.ct s•a►�,4 Pcea��r
Building Plan Review
Occupancy Group: Z3 u l Type of Const:
Fire Marshal:
Other:
Special Conditions: FEES
Building Permit (o37.0
0
Plan Check q I t{ ,
`00 X
Plumbing Fee 570 5 3
d. n Mechanical Fee 577 -
Wood/Gas/Pellet Stove
Violation Fee
Site Inspection
Building State Fee a"
Other
Other
Other �.
Building Valuation: t c3 �� 6 �a TOTAL FEE
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GARY YANDO,DIRECTOR
STgTFo
s
o DEPARTMENT OF COMMUNITY DEVELOPMENT
O T = PLANNING -SOLID WASTE-UTILITIES
N Y y BLDG. I e 411 N. 51 ST. * P.O. BOX 578
of 1664. �o SHELTON,WA 98584 • (360) 427-9670
DISCLAIM[ER/WAIVER OF COUNTY LIABILITY:PERMITS ON EXISTING LEGAL LOTS OF RECORD,
LAND DIVISION APPROVALS, SHORELINE PERMITS, VARIANCES, AND SPECIAL USE PERMITS:
The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations created
by the Growth 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 County's actions in acceptance,processing and/or issuance of such permits or approvals (hereinafter"permitting
actions'),which damages are attnbutable to the County's decision to take permitting actions despite the risk that changes
to the County's development regulations might later make the County's permitting actions invalid.
10,7
Date (Parcel No. or Legal Description)
ro rty o er's si re(Rotarized)
(or the County may accept the signature of the owner's authorized agent upon proper proof♦.404Kization)
I
ACKNOWLEDGEMENT CERTIFICATE (INDIVIDUAL) * N A
v',,,s.2 PU$LZ�'
STATE OF G�xZ��r/c Gi 4 c�t o R
COUNTY OF G
y
On this a vray of in the year , before me Pl�h G✓a �K Notary Public,
personally appeared / �1/(OGLE personally known to me to be the person whose name is
subscribed to this instrument, and acknowledged that he/she executed it.
WITNESS my hand and official seal.
-For County use only-
Reviewed by applicant on
(Date)
Notary' signature
Staff Initial:
ommission Expires:
s��
TITLE NOTIFICATION OF AQUIFER RECHARGE AREA
DATE: b - / PARCEL NO.:LEGAL �ZC'og 7 7 ` �616�
138SCRIPTION: I IL�' VT %Sr � � �� �
OWNER: GcDi�G
NOTICE: This site lies within an Aquifer Recharge Area as defined by Chapter
17.0.1, Mason County Code. The site was the subject of a development for:
List proposal(s), corresponding permit number(s), and application date(s):
APPLICATION
TYPE OF PROPOSAL PERMIT NUMBER DATE
r3j097- 0 732--
E su)cct-7 - o3sg 17 /9
foU�61-17-1v1/ 0NCy/
Restrictions on use or alteration of the site may exist due to natural conditions of
the site and resulting regulation. Review of such application has provided
information on the location of an aquifer recharge area and the restriction-on their.
use. A copy of the plan s ing the aquifer recharge area is attached hereto.
Signature of Owner:
On this day personally appeared before me to me
known to be the individual described i nd who ex u the within.and foregoing
instrument, and acknowledged that , signed the
same as �.�.a , fr and vol ntary act and deed, for the
uses and purposes therein mentioned.
GIVEN under my hand and official seal thisa7&ay of 199-•
_ Notary P i
Expiration Date: a
County residing in
,� '
_ ' �.
FP � �' ,.r
TITLE NOTIFICATION OF AQUIFER RECHARGE AREA
Owner C) n1vEhZZ T'/xrfOLegal Description:
l
Parcel No.:�L2608--77-9616?—
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SITE PLAN
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