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HomeMy WebLinkAboutBLD96-1324 - BLD Application - 10/31/1996 Permit No. MASON COUNTY BUILDING PERMIT APPLICATION �� 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 PLEASE PRINT_ #1 riteAddress J L' S' �Q r n l W a o s Phone# � �/oa Ta8 omG� S�' Fire District# St A)A zip Directions to Job Site G 37VL, w - Owner Mailing Address jEl© D j a a_o m a 5:7f- City St 1J 4 _zip9�- Lien/Title Holder D Address Clty M D a. St�G=Zip #2 Contractor Name N -�-Qh Contractor Reg# Address Expiration Date City e me v4o r� St Zip Phone# 366- &73 -`7;Q_6 / #3 If septic is located on project site, include records. Connect to Septic? Public Water Supply Well ^ Connect to Sewer System? Name of System 1 (If residential, proof of potable water is required) #4 rcel No. - - 3aa 3 �-� m Legal Description �IlIny +"tL P i La_yd _7Q #5 Building Square Footage: (existing/proposed) 1st FI / 2nd FI / 3rd FI / Loft / Basement / Deck / #bedrooms / #bathrooms / Garage / Carport / (Circle:Attached or Detached?) Other Ptov)I V1 so.ft. LZ _ J. L= „R #6 Use of building ±QK,1,,)YZj Al c Till' — Descries ork w #7 Type of Job: New Add _Alt Repair Other cn #8 MOBILE/MANUFACTURED HOME INFORMATION C el Year Mak Model ('� Length Width rial No. # Bedrooms # Bat rooms Type of Heat 1 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 OP� 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 mc,,oc i- D G / �D l f D L a.l re.dd 12 6-iaz 118d) APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW Plumbing Fixtures ($3.25 each) Fee Mechanical Fixtures ($6.50 each) 1 n No._ ilets lRCLE FUEL TYPE: Gas, Electric, Bat Basins H\Heatpumps her _Bath T�ibs N ees Showers BTU Hot Water tr Laundry Was r Systems Sinks Vent Fans Floor Dra' s Ns Com ress s Laund Basins P Di washer No. Air Han lincai its isposal cfm# Urinals No. Fire Prot ion S stems Other _ 'eF Al rm Sys 50.00 e Su p. Sys 50.00 Permit Basic Fee 16.25 _ Sprink Sys 35.00 TOTAL PLUMBING $ No. Gas Outlets Wood, Gas, Pellet St ve 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 16.25 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD 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 9 TH BUILDING DEPARTMENT. DEPARTMENT. WNER �%��- �� X BY DATE /&Z 96 DATE FOR OFFICIAL USE ONLY: Accepted by: Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY Approved Cand. Hold Approval Planning: Environmental Health: i I 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 6w, I40h OQ Other Building Valuation: TOTAL FEE MASON COUNTY PERMIT ASSISTANCE CENTER NOTIFICATION OF PERMIT CANCELLATION Date: 12/09/97 JACK WANS E 100 TACOMA STREET UNION WA 98592 Parcel Number: 322325052017 Legal Description: UNION HOOD CANAL LAND & IMP CO BLK: 52 LOT 17-19 Project Description: ADD AWNING OVER DECK Permit No. : BLD96-1324 Upon review of our records, the Mason County Permit Assistance Center has identified your permit application as being on hold for more than 4 weeks pending more information. The information was requested in order to continue to process your permit application. A copy of the original request for additional information is enclosed. Please provide the information within 15 days from the date of this letter or the application will be cancelled. If your permit is cancelled, you will be billed for the review fees that have been assessed to date. Please call (360) 427-9670, ext. 284 with any questions or if you believe you have received this notice in error. Thank you for your cooperation. Sincerely, Structural Plan Review Mason County Permit Assistance Center attachments tmj CANUERM, rev: 11/24/97 GARY YANDO,DIRECTOR �oN.STA y. P '� o A°u N DEPARTMENT OF COMMUNITY DEVELOPMENT o T 2 PLANNING - SOLID WASTE - UTILITIES �o N Y o~ BLDG. I • 411 N. 5TH ST. • P.O. BOX 578 1864 SHELTON, WA 98584 • (360) 427-9670 DISCLAIMERIVKAIVER OF COUNTY LIABILITY: PERMITS ON EXISTING LEGAL LOTS OF RECORD, LAND DIVISIO ROVALS, SHORELINE PE TS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property o is aware of the u ertainty regarding Mason County's development regulations created by the Growth Management ring Board' Order of October 2, 1996, and in consideration of Mason County's willingness to proceed with proces ' g of ap 'cations w h might be affected by that Order, the undersigned property owner hereby agrees to waive any la uit, a on, for dama s against Mason County which may arise out of Mason County's actions in acceptance, p cessing and/o issuance of ch permits or approvals (hereinafter"permitting actions'), which damages are attributable to e County's ecision to a permitting actions despite the risk that changes to the County's development regulations mi t later the C nty's permitting actions invalid. Date cel or Legal Description) P perty owner's signa r Co}�nty may acce the s* ture of the owner's authoriz agent upon p per of authorization) I ACKNO EMENT CERT VIDUAL) STATE OF COUNTY OF 10001, On this day , in the year ore me Notary Public, personally a personally known to me to b the person whose name is bscribed t his ' to ment, and acknowledged tl /she executed it. WTTNE my hand and offi seal. ,` -For County use only- Reviewed by applicant on (Date) Notary's nature My C on Exprtes: Staff Initial: