HomeMy WebLinkAboutMIS95-00242 Cancelled Dock - MIS Application - 4/12/1995 Permit No. Im I�l�1�-da4 0"1
MASON COUNTY
Tv+s'anJ BUILDING PERMIT APPLICATION
426 W. Cedar/P.O. Box 186, Shelton, WA 98584 427-9670/1-800-562-5628
PLEASE PRINT /
#1 Own i" L L ne# r2 T 7d
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Address n c. Fire District#
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Cty � St ]�_Zip
Directions to Job Site N/, 0 F 4,c
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Owner Mailing Address 6
City /\ ' Stl,�i�Zip
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Lien/Title Holder
Address 11
City M ff _ Sr"11;L_zip
#2 Contractor Name Contractor Reg#
Address Expiration Date
City St Ip Phone#
#3 If septic is located on pr 'ect site, include r ord .
Connect to Septic? Public W Supp
Connect to Sewer S stem? e o stem
(If residential, proof of potable water quired
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#4 Par I No y - / /
egal Description /ALA*49Lf% ':�olXl I 5Zy n
#5 Building Square Footage (existin prop )
1st FI / FI / / Loft /
Basement / ck / edrooms / #bathrooms /
Garage / Carpo / ircle:Attached or Detached?)
Other o e, k sq. "TLdO t�oC KS 37C r2
#6 Use of bwau Describe work
#7 Type of Job: New Add Alt k" Repair Other
#8 MOBILE/MANUFACTURED HOME INFORMATION
Model Year Make Model
Length Width Serial No. APR -5 1995
#Bedrooms # Bathrooms Type of Heat
Purchase Price$ NIENERALSERVICES
#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,
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APPLICANT TO DRAW TOPOGRAPHY PROFILE BELOW l
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Plumbing Fixtures ($3 eac!21 Fee Mechanical Fixtures ($6 each)
No._Toilets CIRCLE FUEL TYPE: Gas, Electric,
_Bath Basins Heatpump, Other
_Bath Tubs No. Units 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 $ N2 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 APPROVAL FROM FIRST OBTAINING APPROVAL FROM THE BUILDING
THE BUILDINGQF9PARTMENT DEPARTMENT.
X OWNER X BY
DATE �?� DATE
[FOR OFFICIAL USE ONLY: Accepted by: 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
Building Valuation: TOTAL FEE
5 ft.
decking 2x4x5 preaser treated
10 ft
side view of deck
2x6x10
E:presure treated
1. poly wraped stirofoam 2 per dock
GARY YANDO,DIRECTOR
STgTFO
• o A°u DEPARTMENT OF COMMUNITY DEVELOPMENT
i o T z PLANNING -SOLID WASTE -UTILITIES
N Y y BLDG. III • 426 W. CEDAR • P.O. BOX 578
of
1864 `V SHELTON,WA 98584 • (206)427-9670
April 6 , 1995
Mr. William Hurley
E 460 Twanoh Falls Drive
Belfair, Washington 98528
Dear Mr. Hurley:
As discussed by telephone today, I am sending you a copy of the
forms needed to process your building permit for a dock on
Erickson Lake. These forms are standard application materials
for docks and are intended to review the building proposal in
respect to the lake shoreline.
The Environmental checklist is returned to the above P.O. box and
processed by Mason County. Some comments may be received from
state/local agencies . The Hydraulic Permit Application (HPA)
should be sent to the address circled on the HPA after returning
the Environmental Checklist to this office. The handout on
construction of piers, docks, and floats is included to show the
application requirements, general permit process , and standards
to be reviewed.
Please contact me if you need additional questions; I have
attached my business card.
Sincerely,
Allan Borden
Shoreline Planner
Recycled
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