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HomeMy WebLinkAboutBLD97-00623 Cancelled Replace Roof - BLD Application - 12/8/1997 MASON COUNTY PERMIT ASSISTANCE CENTER NOTIFICATION OF PERMIT CANCELLATION Date: 12/08/97 DENISE BERCHOT 4410 RUE VILLA NE BREMERTON WA 98310 Parcel Number: 322125000008 Legal Description: TAHUYA RIVER TRACTS TR 8 Permit No. : BLD97-0623 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 CANCPERM, rev: 11/24/97 GARY YANDO,DIRECTOR ��Q, srarFo MC A°u DEPARTMENT OF COMMUNITY DEVELOPMENT N Y �? PLANNING - SOLID WASTE - UTILITIES of Doti BLDG. I • 411 N. 5TH ST. • P.O. BOX 578 1864 SHELTON, WA 98584 • (360) 427-9670 DISCLAPAER/WAIVER OF COUNTY LIABILITY: PERMITS ON EXIST[NG LEGAL LOTS OF RECORD, LAND DIVISION APPROVALS, SHORELINE PERNUTS, VARIANCES, AND SPECIAL USE PERMITS: The undersigned property owner is aware of the uncertainty regarding Mason County's development regulations creatod by the Growth Management Hearings Board's Orller 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 aanbutable to the County's decision to take permitting actions despite the risk that changes to the County's development regulations night later make the County's permitting actions invalid. Date (Parcel No. or Legal Description) Property ow 's signature(Notarized) (or the Coun may accept the signature of the owner's authorized agent upon proper proof of authorization) ACKNOWLEDGEMENT CERTIFICATE(INDIVIDUAL) STATE OF COUNTY OF On this_day of , in the year before me Notary Public, personally appeared 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 - Revi w d b 1 u on Notary's signature (Date) , My Conunission Expires: Staff Initial: Permit No. LD / J MASON COUNTY BUIL ING PERMIT APPLICATION �p vLE►se PUNT &A 4 #1 er ? ICIIAPI— Phone# ba J ite Address_ n �� e� a City St LA) Q Zip Directions to ob Site north 5 hor If,WC4 To Au u`S Ger 11 ek i Ia,61 e4 41_1 SDII (�Lt� �/L Wl �iC Ctfi FofK i ihn K0.1d , Tate TdA4-IT 4 Owner Mailing Address_)X)QQ d'Rhh Ctv e City_i)r_,, M L h as St c'0G ZipZ - Lien/Title Holder Address City St Zip #2 Contractor Name ILi•a .,es/ Contractor Reg# Address Expiration date City St Zip Phone #3 If septic is located on project site, include records. Connect to Septic?�f //� Public Water Supply Well (If residential, proof of potable water may be required) #4 Parcel No. Legal Description 'ia ee- `T'KuGiS #5 Building Square Footage: (existing/proposed) 1st FlS-7(0 / 2nd Fl / 3rd Fl n A / Loft TJ i'r / Basement / Deck YlR / #bedrooms_ #bathrooms Garage 0 / Carport h / (Circle: Attached or Detached?) Other sq ft / f ©V TlbN o �— #6 Use of building Pca7ten Describe work jbl,11313252229otaf S-z-c o wp F L60 — #7 Type of Job: New Add Alt Repair Demolition Woodstove Re-Root_ Bulkhead Other #8 MOBILE HOME INFORMATION MNRN0WTM Model Year Make Model r� Length Width Serial No. � [ 1W #Bedrooms #Bathrooms Type of Heat #9 Any water on or adjacent to property: saltwater HEALTH SERUICrJ river pond wetland seasonal runoff other Show following on the site plan Lot Dimenai6ns Flood Zones Existing Structures Fences Structure Setbacks Driveways Water Lines Shorelines Drainage Plan Topography Septic Systems Wells Proposed Improvements Easements Name of Flanking Street Scale: Name of Fronting Street Date: F_APPLI To DRAW SITE PLAN BELO A,-q , zel� c1 . r v N l� APPLICANT TO DRAW TOPOGRAPHY PROFILE BELO Plumbing Fixtures ($2 each) E= f2a No. Toilets Vent Systems X 3 . 00 Bath Basins Vent Fans X 3 . 00 Bath Tubs No. Boilers/Compressors Showers 0-3 HP 6 . 00 Hot Water Htr 3-15 HP 6 . 00 Laundry Washer 15-30 HP 6 . 00 Sinks 30-50 HP 6 . 00 Floor Drains 50 + HP 6 ' 00 Laundry Basins No. Air Handling Unit Dishwasher <= 10000 cfm. 7. 50 Disposal > 10000 cfm. 7. 50 Urinals Other Other Evap Coolers Hoods Permit Basic Fee 3 . 00 Fire Suppression TOTAL PLUMBING $ Domes. Incin. Comml. Incin. Reloc/Repair 6 . 00 Mechanical Fixtures as Outlets X 2.00 No. Fuel Types �� � Woodstove separate Furn < 100K BTU 6 . 00 Other Furn >- 100K BTU 6 . 00 Furn - Floor 6 . 00 Permit Basic Fee 10 . 00 Heat Pumps 6 . 00 TOTAL MECHANICAL $ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANYTIME AFTER WORK IS COMMENCED OWNERS AFFIDAVIT CONTRACTORS AFFIDAVIT I CERTIFY THAT I AM EXEMPT FROM THE REQUIREMENTS OF THE I CERTIFY THAT I AN A CURRENTLY REGISTERED CONTRACTOR CONTRACTORS REGISTRATION LAY RCW 18.27 , AND AM AWARE IN THE STATE OF WASHINGTON AND I AM AWARE OF THE OF THE MASON COUNTY ORDINANCE REQUIREMENTS FOR WHICH ORDINANCE REQUIREMENTS REGULATING THE WORK FOR WHICH THIS PERMIT IS ISSUED AND THAT ALL WORK DONE WILL BE IN THE PERMIT IS ISSUED AND ALL WORK DONE WILL BE IN CONFORMANCE THEREWITH. NO CHANGES SMALL BE MADE CONFORMANCE THEREWITH. NO CHANGES SHALL BE MADE WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING WITHOUT FIRST OBTAINING APPROVAL FROM THE BUILDING DEPARTMENT. DEPARTMENT. �i X OWNER Z BY DATE = ��-'l� DATE Return permit to: Department of General Services 426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628 FOR OFFICIAL USE ONLY: Accepted by. , Date: DEPARTMENTAL REVIEW FOR OFFICE USE ONLY • Approved card Mold Approval Planning: ' CtC"y ✓��, Environmental Health: I Building Plan Review: Occupancy Group: Fire Marshall : Other: FEES llspecial Conditions : II Ilsite Inspection I II II II U II� II IlBuilding Permit I II II II Q it II II Violation Fee I II II L' ;I II II IlViolation investigation Fee g I II II II li 'I II II II Plan Check I II II II li 'I II II IlPlumbing Fee I II II II I. it II II IlMecha.nical Fee I II II II ;I II II Ilwoodstove Fee I II II li it II— II IlBuilding State Fee ( 11 IlBuilding Valuation: II II TOTALI II L � �