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Home My WebLink AboutCOM2000-00062 LPG Storage Tanks - COM Application - 7/20/2000 PERMIT NO: BLD MASON COUNTY BUILDING PERMIT APPLICATIO -- 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 `` kS S Contractor Name rI (ob. 11 Mailing AddressJ Mailing Address City— - State Zip Code City State Zip Code Phones EaJ Other Ph.( Ph.( Other Ph.( ) Lien/Title Holder Contractor Reg. # Address Expiration 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. /,;Z.3 a 1 10 / O Fire District ' _ Legal Description '` r�! Site Address(Please include street n me, street number and city) Directions to site �� 1 Gtl_lrrllp VNAA.1h 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 Runoff_ Stream Slopes or Bluffs PERMANENT RESIDENCE❑ SEASONAL RESIDENCE❑ TYPE OF JOB New Add Alt Repair Qth Use of Building Describe Work rL _ Es- 6 No. of Bedrooms No. of Bathrooms SQUARE FOOTAGE-1st Floor 2nd Floor 3rd Floor Loft Basement Deck Other sq. ft. Garage Attached Det ched 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-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 ��1✓ Dat -to Z000 X Date FOR OFFICIAL USE BEYOND THIS POINT Accepted by Date Submittal Amount Due Receipt No. DEPARTMENTAL REVIEW APPROVED DENIED CONDITION CODRS Building Department Occ Group Type Constr. Planning Department Environmental Health Department Public Works Department i Fire Marshal Valuation $ FEES Building Permit Fee Site Inspection Plan Review Fee UFC Plan Review Fee Plumbing & Base Fee Public Works Review Fee Mechanical & Base Fee Other Wood/Gas/Pellet Stove Fee Other Violation Fee Pre-Paid at Submittal ( ) TOTAL FEES:: FORM MUST BE COMPLETED IN INK PERMIT NO.: _ PLEASE PRESS HARD MASON COUNTY PLUMBING/MECHANICAL PERMIT APPLICATION 426 W.Cedar/P.O.Box 186,Shelton,WA 98584 Shelton 360 427-9670 Belfair 3601275-4467 Elma 369_)482-5269 Seattle 206 464-6968 APPLICANT INFORMATION CONTRACTOR INFORMATION Owner `7).i JQC� nr wA &LV__ Contractor Name _ Mailing Address 7777_q2,c"-7, i3c�2c�. �!�-; Mailing AddressX Cit 14 State 4 - Zip Code City fate -Zip Code Phone_42.S ? - ( 04A Other Ph. (o0 %V( 2 Ph.L__ Othe P .C� Lien/Title Holder Contract . # Address ExpiraWn II'AYC=Vz,.> SEPTIC INFORMATION-Connect to New Septic Existing Septic Connect to Sewer System Name of Sewer System PARCEL INFORMATION-12 digit Tax Parcel No. 1 'Z3'Z1 1 / OU / to—to Fire District Legal Description Site Address(Please include street name, street number and city) NL .43 1 L-,O6 �uzl"Z.12 (Z-o•,-0 Directions to site 0 c - 1 V�z WIC �S'►�A,2C •'ll�t Q+2-a�P�=�2i��, E IF��MA�_`��r✓�t'14 ►��va-S'�j✓ �r(/�e2 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 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 7— 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-1 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 app val. nn first obtaining approval. 1 Date � � X Date FOR OFFI IAL USE BEYOND THIS POINT Accepted by - Date ,S7 1`� `rtubmittal Amount Due Receipt No. #TEPATtTIVI NTAC # 1li�W: 11PPIR VIED DENIED GONR1€I0`N>GL)DES Building DepartmentMP Occ Grou 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 F-ARM MUST BE COMPLETED IN INK PLEASE PRESS HARD MASON COUNTY PROJECT SITE INFORMATION Case No. Name C ox � —��< ARCEL NUMBER/gVd/--/0-0/070 Date r7 Zo/-Z-� SHO HE FO LOWING 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 Topography 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 line4 I , Fadjacent 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 1 I I I I I I I � I 1 I I I I I I I I I I adjacent property line-) F-adjacent property line SAMPLE SITE PLAN adjacent property line-� ,ram_ 3io' ruescrz�e E-adjacent property line D 30' So-� CRF�1G c Hom L, I � G rxaGu I H O c.li G_ PRO POSLD 5¢Qfi L 1 I t4— 60 I I VAL Pn T i fi Gr�RAck 30 vr�oPoscn So' I \ � naitzGu.LrL,-nAL yo- I / I - ; K � k--e o• --91 I \ I \ I c.—GLL I I 1 I /00' --� I adjacent property lined Fadjacent pro�ert 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 F�l R11 51 o p a f a dia�anc¢ to dL Rinnntl D to