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Home My WebLink AboutBLD94-0416 SFH - BLD Application - 4/4/1994 Permit No. MASON COUNTY (3.4.,- -1 a ,ry M 1S9 (t-0�;3 BUILDING PERMIT APPLICATION 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 6,0A{`}�0 PLEASE PRINT `� #1 Owner v; Phone# Site Address J Fire District# City GVx ��.5^ l _ St ` Zip Directions to Job Site Q„ C, x4 ,, Owner Mailing Address City �� St Zip Lien/Title Holder Address Clty St Zip #2 Contractor Name Contractor Reg# Address Expiration Date City St Zip Phone# #3 If septic is located on project sp* ipclude records. Connect to Septic WY Ptt� V t r Supply`VS Well Connect to Sewer ysS tem? Name of Sys e'f m (If residential, proof of potable water is required) cP C4 --� #4 Parcel No.'��vl�- - Legal Description 5 #5 Building Square Footage: (existing/proposed) 1 st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle: Attached or Detached?) Other sq. ft. / #6 Use of building Describe work #7 Type of Job: New Add Alt Repair Other #8 MOBILE/MANUFACTURED HOME INFORMATION Model YearLZ3Q Mak a Model Length j� Width�O ; S al No. C #Bedrooms,2_# Bathrooms _Type of Heat Purchase Price$ 4, no, nn #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 Show following on the site plan Lot Dimensions Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Indicate Directional by (N, S, E, W) Name of Fronting Street in relation to plot plan APPLICANT TO DRAW SITE PLAN BELOW v �fir r/t 5T APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbina Fixtures ($3 each) Fee Mechanical Fixtures ($6 each) No. Toilets CIRCLE FUEL TYPE: Gas, Electric, Bath Basins Heatpump, Other Bath Tubs No. Unita Fees Showers _ Furn BTU Hot Water Htr — Heatpumps _Laundry Washer _ Vent Systems Sinks _ Spot Vent Fans Floor Drains No. Boilers/Compressors _Laundry Basins — HP Dishwasher No. Air Handling Units _Disposal — cfm# _Urinals No. Fire Protection Systems _Other _ Auto. Fire Alarm Sys 50.00 Fixed Fire Supp. Sys 50.00 Permit Basic Fee 15.00 _ Auto Fire Sprink Sys 25.00 TOTAL PLUMBING $ No. Other Gas Outlets Wood, Gas, Pellet Stove 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 15.00 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD 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 OF THE 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 PPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING THE BUILDING DE:717ARTM DEPARTMENT. X OWNER L X BY DATE C DATE MOM. use oN�. te Y Date. DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cond. Hold Approval Planning: Environmental Health: Building Plan Review Occupancy Group: Type of Const: Fire Marshal: Other: Special Conditions: FEES Building Permit Plan Check Plumbing Fee Mechanical Fee Wood/Gas/Pellet Stove Radon Monitor Violation Fee Site Inspection Building State Fee Other Other LBuilding�Valuation:— TOTAL FEE �, PLOT PLAN ADDRESS PERMIT NO. 0 LEGAL ; DESCRIPTION ; LOT c BLK ° ADDITION SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Y Sq. Ft. INSTRUCTIONS TO APPLICANT THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"-20' ARE FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.) FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN- SIONS, SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STRfiET ELEVA- TION AND SEWER SERVICE ELEVATION. SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR- TION THEREOF. INDICATE NORTH IN CIRCLE PH,-$ '" ARE 5' X 5' OR 1"=20' I 1 — —Y__--�--------+—_' , i I I/We certify that the proposed construction will conform to the dlmerniohs and uses shown above and that no changes will be made without first obtaining approval. AME(S) OF OWN-11_ OF 717E S STRUCTURE(!) (PRINT) I NA TUR OF WNER171 OR AU THORI p DO NOT WRITE BELOW THIS LINE E N Iv STRICT APPROVED AS NOTED DATE MASON COUNTY DEPARTMENT of GENERAL SERVICES Mason County Bldg. III 426 W. Cedar P.O. Box 186 Shelton,Washington 98584 (206)427-9670 BUILDING PARKS& RECREATION FAIR/CONVENTION CENTER ADMINISTRATION APRIL 4 , 1994 MEMORANDUM TO: PUBLIC WORKS DEPARTMENT FROM: MIKE BYRNE, BUILDING DEPARTMENT RE: ROAD PERMIT DONNA AND DAVID FUGIT HAVE APPLIED FOR A MOBILE HOME PERMIT AND HAS CONTACTED LABOR AND INDUSTRIES FOR UPDATE OF MOBILE. THE BUILDING DEPARTMENT HAS APPROVED THE TRANSFER OF THE MOBILE FROM KITSAP COUNTY TO MASON COUNTY. PLEASE ISSUE A ROAD PERMIT FOR THE TRANSFER OF THIS UNIT INTO MASON COUNTY. OCCUPANCY WILL BE CONDITIONED ON PERMIT. THANK YOU. MIKE BYRNE, BUILDING OFFICIAL -P �. Department of Labor&Industries ALTERATION PERMIT Factory Assembled Structures Section Do not complete shaded areas INSTRUCTIONS: ermit# 12 386 1. Complete all spaces to and including the box with the signature X in it. Invoice# 2. Then draw map on reverse side of WHITE copy only. - 3. Submit completed permit and fee to the nearest office listed on the back. 4. Contact and schedule the inspection with the office in which you submitted the permit Insignia# within 15 days. Owner last name first name Day time phone Date .............................:.....................................................:..........................................................................__..........-----................ 1...........-.......................................... Address �.— City State ZIP r Installer/Contractor/Dealer Phone Contractors registration number Address------------------........•.......•.............. ...------- .---------------------------------- ...........------------------ ..... C.. ity------...................................•............ State ZIP+4...... Check the appropriate boxes in section A and section B. FEES A B Alteration Inspection(check appropriate boxes below) $75.00 ❑ Commercial Coach Air Conditioning/Heat Pump Serial No, Electrical Electrical Appliances Mobile Home Fire Safety Serial No; Gas Furnace Gas Piping HUD No. Plumbing Structural Serial No. LjRecreational Vehicle or ❑ Park Trailer Wood/Pellet Stove — — Serial NO. Plan Review — —— —— — — —— — — —— —— -— —. $70.00 RV Inspection — —— — — —— —— —— —— — — — $75.00 , Model No.or Plan approval No. Re-Inspection— - --- No.ngmaermrt $50.00 Technical Inspection --- - - -- -- -- -- - $50.00/hr 't Signature of applicant or authorized representative Make check payable to: Dept.of Labor&Industries X FEES DUE s e artment use only Request APPROVED or Request DEIFIED because of Specific Violations Of Washington Rules And Regulations. Violations Must Be Corrected And ReInspection Requested Within 10 Days For Recreational Vehicles And 20 Days For Mobile Homes and Commercial Coaches of the notice of violation date.'(This does not apply to technical inspections)'. It Is Unlawful To Offer For Sale,Rent,or'Lease'Any Non-complying Mobile Home,Commercial Coach or Recreational Vehicle. r: f - . . . . _ • - - - • - - -- - - - - - -- - -- - -- - - - - -- - - - - - - - - - - - - - - - - -- - - - --- - - - - --- - - - - - - - - - - - - - - - --- - - - - -- - - - --- - - - --- - - - -- - - - - - - - - -- ---- - - - - - - - -- - - - --- - - - --- - - - - - - - - - - - - - - - - - - - - - - -- - - - - -- - - - - -- - - - - -- - - - ---- - - - - - - - - - - - - - - - -- - - - -- - - - - -- - - - - - -- - - . .. . . . . . . Included are forms required which must be completed and fees submitted before reinspection. Date Area office Inspector TttD F622-012-000 alteration permit 12/91 White-Olympia Green-Contractor Canary-Inspector Pink-Purchaser Goldenrod-Purchaser Draw map givingdirections to location on the WHITE COPY ONLY. EAddress State Lip N W E i` S Dept.of Labor&Industries Offices ABERDEEN EVERETT OKANOGAN TUKWILA 415 W Wishkah Evergreen Way Business Center 1234 2nd Ave S 12806 Gateway Dr PO Box 66 8625 Evergreen Way Ste 250 PO Box 632 Seattle WA 98168-3311 Aberdeen WA 98520-0013 Everett WA 98208-2620 Okanogan WA 98840-0632 (206)248-8240 (206)533-9300 (206)290-1346/1347 (509)826-7345 *Effective Feb. 15,1992 BELLEVUE KELSO OLYMPIA VANCOUVER 616 120th Ave NB Ste C201 711 Vine St 805 Plum St SE 10401 NE Fourth Plain Rd Bellevue WA 98005-3037 Kelso WA 98626-2621 PO Box 44430 Vancouver WA 98662-6302 ' (206)455-7048/7074 (206)577-2200 Olympia WA 98504-4430 (206)696-6295 (206)586-6085 BELLINGIIAM KENNEWICK WALLA WALLA 2500 Elm St Ste F 500 N Morain Ste I I10A PORT ANGELES 1815 Portland Ave Ste 2 Bellingham WA 98225-2732 Kennewick WA 99336-2607 1026 E 1st St Ste 1 Walla Walla WA 99362-2246 (206)676-2083 (509)735-0100 Port Angeles WA 98362-4020 (509)527-4437 1-800-544-1509 (206)457-2572 KENT WENATCf IEE SPOKANE BREMERTON 19435 W Valley Ilwy E 3901 Main Ave 123 Ohme Gardens Rd Ste 203 4841 Auto Center Way Ste 201 Bldg S Ste 108 TAF C33 Wenatchee WA 98801-9634 Bremerton WA 98312-4379 Kent WA 98032-2114 Spokane WA 99220-4033 (509)663-9713 (206)478-4926 (206)277-7272 (509)456-2793 *Until Feb. 15,1992 YAKIMA EPHRATA 1716 S 16th Ave T 21 C Street SW MOUN VERNON 1 ACOMA Yakima WA 98902-5789 1305 Tacoma Ave S Ste 305 509 454-3760 Ephrata WA 98823-1895 1220 Memorial Ilwy ( ) (509)754-4608 Mt VernonWA 98273-3262 'Tacoma WA 9 84 02-1 9 88 (509)754-4608 Mt V rnon 50 (206)596-3814 the following offices will be moving in the near future. Locations not known at this time. Kelso Mount Vemon i