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Home My WebLink AboutBLD2001-01313 SFR - BLD Application - 12/21/2001 PERMIT NO,; BLDM It�31� 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 Contractor Name Mailing Address Mailin Address City State Zip Code Aft City State Zip Code Phone( ) 42`1- 17S.)Dther Ph.( ) Ph. - Other Ph. Lien/Title Holder Contractor Reg. # V Address SE 5 ,L&e- Expiration - / 01 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. ZO v Fire District Legal Description Site Address(Please include street name, street number and city) Directions to site Will ber be cut sold in parcel preparation? (Yes/No) Is your pr p within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluf S PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New_L .,'Add Alt Repair Other Use of Building Describe Work N L-t No. of Bedrooms _No. of Bathrooms_ SQUARE FOOTAGE-1st Floor 1"IQ22nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Detached Carport Attached Detached MOBILE HOME INF MATION-Make Model Model Year Length idth Serial No. No. of Bedrooms No. of Bathrooms Type of H Purchase Price $ Replacement Unit ?(Yes/No) Install ame 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-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 obtaini g approval. X Date X ! / Date FOR OF IAL USE BEYOND THIS POINT ��'jj� Accepted byM� J1 Date Submittal Amount Due Receipt No.c j� DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODES Building Department Occ Grou K3 O TypeConstr. ,57V Planning Department 7 ICE ' �0 0 Environmental Health Department Public Works Department I Fire Marshal -14 Valuation $ �i 38D FEES Building Permit Fee 8�.�5 Site Inspection Plan Review Fee EH Review Fee Plumbing& Base Fee 75 Planning Review Fee Mechanical&Base Fee �09 Other ,d/Gas/Pellet Stove Fee State Fee — 'ee p4p ENPre-Paid at Submittal TOTAL 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 APPLICA T ORMATION CONTRACTOR INFORMATION Owner f I I Contractor Name YtWW 1nL. _ MaiIi ss GI Maili Address vf- City State ''1J Zip Code City State 14.R Zip Code Phone Js Other Ph.( Ph. - Other Ph. lLien/Title older fGL.. Contractor Reg. # / Y N 10 AddressI440,1Z) r Expiration / / 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 I"N145W Z(G Site Address(Ple a Inc[ a str et me, st tL cumber and city) i Directions to site �� C�u S � D'n J r1 0 n J \t oy) A t Oh 1 f. Is your pro within 200' of the following: Body of Water (Name) Saltwater Lake River/Creek Pond Wetland Seasonal Runoff Stream Slopes or Bluffs- OF OF JOB New 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 Unit No. of Units Fees Bath Basins Furnace Bath Tubs Heatpumps Showers Vent Fans Water Heater Propane Tank Laundry Wsher Gas Outlets Sinks Wood/Gas/Pellet Stove Dishwasher = Direct Vent? Other Other Other Other Base Fee 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-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 d0 in conformance therewith. No changes shall be made without approval. first obtainiLal. X Date X ate FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTAAENTALOMEW:.. EiPI ROVED DEltiflkb CDtS1Cl1 110 i:00V 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 FORM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION (� }�^ Case No. Name i�,�L'Ic1 I I .�,U� PARCEL NUMBER`'�"2 C'[kf P4V I1V �Date 1 Z " ( Z 1—'Y 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 Topographv 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- adjacent property line I I I I I I I I I I I I I I I I I I I I I I I I I I � I I I I I I I I I I I I I I I I I I I I � I I I adjacent property line- I Fad'acent propprlyline SAMPLE SITE PLAN adja t property line--> 32-o, ravE _ _ I f-adjacent property line D 30' ao-> �EASo r✓AL � r1 � _�PT7L--—'� CREEK I I4— 6 0 I I VACANT I Go I'tA.E I� �rioPascn so'-� I \ � /+&RzCu.Lru..rinL I I c..eLL I I I I A I adjacent property line- ; I R'. c \i F adjacent properf� 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 dt st�,-.c� fie Srt ructt.�►�� 8;-star.- t0 dls+anca. to dL r Signature Date I I I f Inc HOr►'G t— �' C -Tf T-7 V� -2 14 s N t,ARAI,� J zz TA s M 1 � ZD— r I THE IffORMi TION ON THIS PLOT PLAN HAS BEEN PROVIDED AND REVIEWED THE PROPERTY OWNER WHO,BY SIGNING BELOW:1.) ACKNOWLEDGES a 331,�43' ;LWD COMPLETENESS:2.)IS RESPONSIBLE TO ENSURE THAT THE M0� IMPROVEMENTS TO THE SITE TAKE PLACE IN CONFORMANCE WITH THIS PLC N:3.)WILL ESTABLISH ALL THE CORNER IRONS,LOT LINES AND(,'=' �f AQ01,1� �tNDt + 7 S�At REQUIRED SETBACKS REQUIRED OF THIS PROPERTY ANY CHANCE(S'T rLAN MUST BE PRE-APPROVED 6'THE NMENTAL,-t E iC!ES:.'I; JJRISDICTION,THE MORTGAGE LEND AN THE CONTRACTOR AND CuC ENTED. I�14S-01 OWNER DATE I V OWNER DATE